Transforming the Health and Social Care System Across the Dorset Area

Better Together: Transforming the Health and Social Care system across the Dorset area Business Plan (2014 – 2017) Contents Document ControlStandard DCC version control table here, if required Disclaimer or other publication notes here, if required If not required then delete this page 1.1 SummaryThe people living in the Dorset area (defined as the places within the Borough of Poole, Bournemouth Borough Council and the County of Dorset) access health and social care services via 13 primary healthcare localities which in turn mainly access four NHS hospital trusts and a number of smaller community hospitals. Care services, particularly around support for independent living (housing) are accessed through the six district councils that make up the County of Dorset, as well as the three first-tier councils.Funding streams and local arrangements are fragmented reflecting single agency approaches with a relatively low use of pooled budgets or aligned commissioning.At operational and tactical levels, the eight principal organisations often do work together. For example, there is a single Public Health Team across the three authorities, a joint Archives Service, and a joint Skills and Adult Learning Service. There are also some local approaches to focusing resources on preventative services and initiatives to reduce demand on intermediate and secondary care, and on reablement to enable people to live independent lives. The NHS and three local authorities together enjoy the existence of a single Clinical Commissioning Group which is the third largest in the country.All parties recognise that without change the increasing demands placed on the health and social care services by Dorset’s ageing population will make those services unsustainable in the longer term, financially and in terms of available resources, skills and expertise especially to local authorities.Funding reductions and Government initiatives such as the Better Care Fund aim to re-model services and funding streams, this creates stress and shortage in particular areas which cannot be addressed by individual organisations – they require change across the systemThe system itself needs to be re-designed, focusing on a coherent approach across all service providers or agencies. The eight principal health and care organisations will work together as the Dorset-area Partnership to deliver a strategic programme of change: the Better Together Programme, with the key aims of  Managing long-term conditions, especially those amongst the increasingly large cohort of older people living in, and migrating to, the Dorset area4  Reducing the demand (need) for high cost care (acute hospital interventions and long-term residential and nursing care)  Enabling much more care to be delivered locally and enabling people to live independently for as long as possible The Partnership will integrate functions to create person-centred, prevention- oriented support: enabling the outcomes expressed in National Voices and Making it Real, focused initially on older people with significant long-term health and care support needs  Responding to need – the ‘front-end’ of support such as easy to access points of contact, improved information and advice, reablement/ intermediate care, technology, accessible homes (via district councils);  improving effectiveness - new ways of working for social care fieldwork services, especially for assessment and support planning processes across the three local authorities, and improved information sharing with Health, supported by an integrated ICT system ;  integrating commissioning - shared commissioning functions across the CCG and the three local authorities: use of resources, pooled and aligned budgets, common principles and priorities and working with providers to develop the market for care and support;  integrating service delivery - integration for acute, community and primary health and social care, with enhanced community health and social care co-located services fully integrated with all primary health services and delivered by multi-disciplinary teams  Sharing delivery - of local authority provided services across Bournemouth, Poole and Dorset.The Dorset-area Partnership will progress integration based on evidence of what works nationally and locally. The development of integrated locality health and social care teams will be fundamental in addressing the increasing emergency attendances and admissions and supporting the work of the Dorset Urgent Care Board. The core components of the new system will be: a) Increasing the pace and scale of initiatives aiming to provide ‘care closer to home’ to achieve targets on shifting from institutional care to self-help and community based systems b) Developing whole-systems outcome-based commissioning to reflect best value. The range of outcome measures that would drive these commissioning intentions is described in Section 4.3.5 c) Developing new ways of working within and between agencies which aim to maximise and measure the added value of providing direct support to people who need help. d) Working with communities and individuals to help themselves by providing timely enabling interventions which reduce the need for crisis or longer-term statutory services. e) Informed by evidence of what works locally, nationally and internationally and from the experience of our populations and people who use our services when developing new approaches. The programme will deliver these core components within the next three years to be able to achieve a sustainable Health and Social Care system for the future. The high-level programme priorities reflect the immediate actions needed to improve service responsiveness and start to divert and manage the increasing demand for institutional and acute care. The longer-term objectives reflect the intention to re-commission services against a clearer set of whole- system outcomes which are delivered through integrated commissioning arrangements. The programme for integrated commissioning will include demand management, developing the new infrastructures for services and sharing market management, contracting and procurement responses.Across the eight partner organisations there is the financial and resource capacity to deliver this programme. Much of this will be workforce-led work supporting people undergoing change – training, new role definitions, compensation, change management and communications to staff and other supplier-end stakeholders. Health Education England is supporting the programme in this areaThe programme will require some additional specialist support. Much of this at the advice and consultation end of the spectrum will be forthcoming from DH and DCLG via the Public Service Transformation Network and other sources of assistance. The programme has defined eight broad outcomes, these are: A. Total system costs reduced by 5% (of £1.2bn = a reduction of £60m) B. People have independence, choice and control C. Resources are used efficiently and effectively D. People are better able to help themselves E. Joint resource planning responds to need and local people’s priorities F. People experience better outcomes through safe, co-ordinated quality care6 G. Informal support maximised caring for people at home H. A capable, sustainable motivated workforceA key outcome of the Better Together programme will be to reduce the operating cost of the whole health and social care system by five percent, as described above. This will be achieved through delivery of benefits realised from changes the programme will put in place across the system, resulting in reduced: demand or need at the front of the system; waste (inefficiency) through and across the processes, pathways and interventions; and prices for the services provided to users of the system.The Better Together programme is a co-ordinated set of programmes and projects. Some of these have been defined specifically as part of the Better Together collaboration across the eight partners; some originate in other cross-agency initiatives (for example the Urgent Care Programme) and some that are existing or planned initiatives in individual agencies. Together they will implement a re-design of transformation of the system – a new operating model – that will deliver the benefits and achieve the desired outcomes.The principal challenge – which all partners recognise – is that of aligning the programme with the needs and interests of the eight agencies: while there is much common interest in transforming the system – such as funding, contact and process. There is also the reality of moving large organisations towards a joint goal – a difficult challenge which succeeds or fails on the capability of the programme to keep the majority of interests aligned over the next three years. Stakeholder management and strong inclusive governance will be key enablers.7 2.1 IntroductionThis business plan has been produced to provide the sponsors of the eight health and social care agencies in the Dorset area partnership and the Dorset and Bournemouth and Poole Health and Wellbeing Boards to set out the future intentions and activities to deliver integrated services. The plan intends to set out the vision, the case for change and the expected economic and financial benefits of the proposed changes.The plan is a fairly detailed document written primarily for the Health and Wellbeing Board members and staff involved in the delivery of the projects and programmes. Whilst the document will be made available to the public, easier to read formats will be developed as part of the communications and engagement work.The plan provides the structure for the local activity of the Better Together transformation programme but also acts as the source document for the Better Care Fund planning requirements. Each statutory Health and Wellbeing Board will need to sign off a plan for the use of the fund. The Fund plan must be developed as a fully integral part of the Clinical Commissioning Group‘s wider strategic and operational plan, but the Better Care Fund elements must be capable of being extracted to be seen as a stand-alone plan.The vision and strategy for the programme is set out in Section 3, The Case for Change. This builds on the existing priorities for the Health and Wellbeing Board strategies1 and reflects service-user and carer feedback both locally and nationally.The costs and benefits of the proposed programme activity are set out in Section 4, The Economic Plan. The eight expected programme outcomes are summarised in Section 4.3. This section maps the way the benefits will be measured for the duration of the programme to check the impact of the change and to determine whether the eight outcomes have been achieved.Sections 5 and 6, The Financial Plan and The Delivery Plan, provide the detailed funding services and costed benefits expected during the implementation of the programme. A summary of the projects is provided in Appendix A. The resources needed to deliver the programme are also covered under this section.1 (Reference Strategy HWBB Dorset HWBB Bournemouth and Poole 8 The plan will need to be reviewed annually to reflect changes needed to respond to a dynamic environment and the programme board’s monitoring of the success of the projects. 9 3.1 The Case for Change – vision and strategy1.1 Business needThe current system The people living in the Dorset area (defined as the places within the Borough of Poole, Bournemouth Borough Council and the County of Dorset) access health and social care services via 13 primary healthcare localities which in turn mainly access four NHS hospital trusts and a number of smaller community hospitals. Care services, particularly around support for independent living (housing) are accessed through the six district councils that make up the County of Dorset, as well as the three first-tier councils. The Dorset area has a single Clinical Commissioning Group that governs and commissions services across the 13 primary healthcare localities, and in this respect can commission primary, intermediate and secondary/acute services across the or operates services individually, focusing on their own priorities and needs for their own area. Funding streams and local arrangements are fragmented reflecting single agency approaches with a relatively low use of pooled budgets or aligned commissioning. At operational and tactical levels, the eight principal organisations often do work together. For example, there is a single Public Health Team across the three authorities, a joint Archives Service, and a joint Skills and Adult Learning Service. There are also some local approaches to focusing resources on preventative services and initiatives to reduce demand on intermediate and secondary care, and on reablement to enable people to live independent lives. The NHS and three local authorities together enjoy the existence of a single Clinical Commissioning Group which is the third largest in the country. Up until this point there was not an agreed over-arching policy, strategy or machinery that could bring about a coherent pan-Dorset approach to join-up services, enable straightforward access to health and care services, drive efficiencies (and reduce costs) by co-ordinating, sharing and joint service approaches, and to drive prevention that will reduce demand (need) for increasingly costly residential and acute services.10 Key issues Three-quarters of a million people live in the Dorset area, with the second largest conurbation in the South West, several towns and many small villages across a rural landscape. It has one of the highest proportions of older people with high impact care needs in the country. This, combined with a high number of people with resources to fund their own care and increasing number of carers, puts the Dorset area at the forefront of the demographic challenges that face the UK as a whole.  All parties recognise that without change the increasing demands placed on the health and social care services by Dorset’s ageing population will make those services unsustainable in the longer term, financially and in terms of available resources, skills and expertise. Authority 2013/14 , £mNHS Dorset Clinical Commissioning Group* 915.0 (note, this sum is for whole population, not just adults) Dorset County Council 140.8 Bournemouth Borough Council 76.0 Borough of Poole Council 55.0 Public Health* 18.8 Total gross spend on Adult Health and Social Care across the Dorset 1,205.6 area From: Dorset Clinical Commissioning Group, Dorset County Council, Bournemouth Borough Council and Borough of Poole Council.  Funding reductions and Government initiatives to re-model funding streams creates stress and shortage in particular areas which cannot be addressed by individual organisations’ initiatives – they require change across the system.Fig n: The Funding Gap At a strategic level there the Dorset-area could offer more choice and competition in providing support and treatment. The ‘siloed’ nature of the workforce in health and social care organisations serves to lock-in talent and resource making it hard to direct it more freely and purposefully around the system. This creates an imbalance between 11 services with an over-resource (and cost) in one area and service gaps in another.  Audits and individual feedback show that there is significant waste in the system, both within individual agencies and between them. An agency may be able to address waste through tactical re-design and continuous improvement initiatives, but to reduce waste across the system requires a system-wide transformational approach  Most people regard the care they receive to be acceptable or good, and often excellent. However, too many people feel that navigating and accessing care – particularly if there is a need to coordinate several health and care interventions is characterised by long delays, duplication, and being ‘lost’ in the system.  And, a lack of flexibility with some interventions driven by the incentives and penalties inherent in the system (ie: organisational rather than people-focused) leave people feeling helpless and confused. Without change, the provision of health and social care in the Dorset area (and probably across the rest of the UK) will simply become unaffordable. This will lead to increasingly poor health and care outcomes for citizens, impacting most severely on the frail older people and those with long-term or chronic conditions, and particularly those who are socio-economically disadvantage.Resolution There is a commitment and determination by partners that the current health and social care system characterised in the previous section will need to be changed. It is not enough to maintain the existing mechanism and make local or tactical changes to make local or tactical improvements. The system itself needs to be re-designed, focusing on a coherent approach across all service providers or agencies. The eight principal health and care organisations will work together as the Dorset-area Partnership to deliver a strategic programme of change: the Better Together Programme, with the key aims of  Managing long-term conditions, especially those amongst the increasingly large cohort of older people living in, and migrating to, the Dorset area  Reducing the demand (need) for high cost care (acute hospital interventions and long-term residential and nursing care)  Enabling much more care to be delivered locally and enabling people to live independently for as long as possible12 13 1.2 The future visionPrinciples“Bringing services together to respond to what is important to the people we serve” The Dorset-area Partnership is committed to transforming health and social care services across the Dorset area, to enable and deliver a sustainable improvement in health and care outcomes through: Person-centred, outcome-focussed, preventative, co-ordinated careThe Partnership will integrate functions to create person-centred, prevention-oriented support: enabling the outcomes expressed in National Voices and Making it Real, focused initially on older people with significant long-term health and care support needs Then it will look to expand the programme to include new cohorts and create a unified model of health and care across the Dorset area. The Partnership has a clear approach and a partnership-wide programme to shape, coordinate and drive individual projects across five areas of intervention:  Responding to need – the ‘front-end’ of support such as easy to access points of contact, improved information and advice, reablement/ intermediate care, technology, accessible homes (via district councils);  improving effectiveness - new ways of working for social care fieldwork services, especially for assessment and support planning processes across the three local authorities, and improved information sharing with Health, supported by an integrated ICT system ;  integrating commissioning - shared commissioning functions across the CCG and the three local authorities: use of resources, pooled and aligned budgets, common principles and priorities and working with providers to develop the market for care and support;  integrating service delivery - integration for acute, community and primary health and social care, with enhanced community health and social care co- located services fully integrated with all primary health services and delivered by multi-disciplinary teams  Sharing delivery - of local authority provided services across Bournemouth, Poole and Dorset. The Partnership’s strength in delivering this transformation is in the strong, formal commitment from the top of the eight organisations and a strong and inclusive 14 relationship with the Health and Wellbeing Boards. The Partnership has the ability to influence other public, independent, and voluntary organisations, including them in the integrated commissioning and delivery model. The diagram on the following page represents the relationships of services and support as they apply to the person seeking help. “Below the line” supports such as universal services (information and advice) and social capital (community networks, friends and family) are areas the programme describes as the “front-end of support” and are vital to diverting demand from the more expensive tertiary and secondary services shown above the line. Running through all intervention and relationships is a common set of shared values and principles which inform the way we work, centred around and focused on better outcomes for the person. The new system will be re-designed to place the person and their needs at the centre, from a common approach to commissioning services, through the management and co-ordination of a person’s care – clinical and social, the contacts a person has with the system: information and choices, the planning of a person’s care, appointments and visits, interventions and procedures, to the way a person’s information is held and used across the system – consistent use of the NHS Number being a straightforward example. Everything the organisations that make up the system do will be for the benefit of people – the service users, and their carers. Outcomes are ‘whole-person’, covering clinical interventions and non-clinical care; independence, choice and control; social inclusion; and wellbeing. They will be measured and evaluated on that basis. While this should be a fundamental for all users of the health and care services across the Dorset area, it is particularly important for people with long-term conditions, a major cohort of which are frail elderly people. This supports the key principles National Voices is promoting ie that integrated care must:  be organised around the needs of individuals (person-centred)  focus always on the goal of benefiting service users  be evaluated by its outcomes, especially those which service users themselves report  include community and voluntary sector contributions  be fully inclusive of all communities in the locality  be designed together with the users of services and their carers  deliver a new deal for people with long term conditions  respond to carers as well as the people they are caring for  be driven forwards by the commissioners  be encouraged through incentives15  aim to achieve public and social value, not just to save money  last over time and,  be allowed to experimentInitially, vertical service integration will improve outcomes for people needing help in between these tiers. Horizontal integration will improve collaboration of support and services working to address a similar level of need. This recognises that change needs to take place at a practice level (micro), service configuration level (meso), and a whole system level (macro) in order to fully realise the benefits sought by the Partnership.16 Fig n the new system – context diagramScope of the Better Together programme1. Customers or service-users – the people who live in the Dorset area Initially, the programme will focus on frail elderly, particularly those with long- term conditions, as these cohorts are the most challenging in terms of volume and need, and especially for impact on the costs of delivering services. However, the principles of straightforward access, self-service, integration and co-ordinated commissioning apply to virtually all user cohorts where there is the likelihood of episodes of care or a programme of interventions with a person. Thus the programme recognises that it can widen its scope to include (for example) adults with learning disability, mental health, drugs and alcohol rehabilitation, children’s health and well-being, and preventative programmes. This wider scope will be the subject of additional business plans: this business plan relates to the initial scope of frail older people and people with long-term conditions.2. Organisations and services The principal organisations concerned with this programme are the eight members of the Dorset-area Partnership:  Dorset Clinical Commissioning Group  Dorset County Council  Bournemouth Borough Council  Borough of Poole  Dorset County Hospital NHS Foundation Trust  Dorset HealthCare University NHS Foundation Trust  Poole Hospital NHS Foundation Trust  The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust In addition, the programme will involve the six districts of Dorset and the range of local and community organisations that are part of the wider provision of health and social care in the Dorset area.3. Services & initiatives17 The following initiatives comprise the core of the programme. These are described in more detail in the following section 3.3. A shared “front end” of support between the three local authorities and establish robust links into Health “single point of access” arrangements, comprising: a) Shared information and advice service b) Shared support and advice services in the acute hospitals c) New self-funder support services which will become self-financing. To include access to financial advice, brokerage and out-sourced social work assessment d) Shared reablement model across Poole, Bournemouth and Dorset based on a consistent access arrangement e) Working with the district and borough councils of Dorset, the development of robust links, and possible co-location, with the new integrated information/advice/service access arrangements for aids, adaptations and accessible homes f) Urgent care g) Integrated locality teams. A new operating model and revised and integrated business processes between local authority fieldwork teams, supported by a shared ICT system, in order to provide responsive services able to work more closely with health partners in preparation for greater integration into the future. Shared commissioning structures and practice across the three local authorities, Public Health and the Clinical Commissioning Group. A common market position statement and shared market management, and work with service providers. Shared, directly provided services.Benefits Expected financial and efficiency benefits that derive from the projects and initiatives, and which lead to customer and organisational outcomes are listed below:  Enhanced market and local economic development arising from more opportunities to invest at scale in health and care private, social enterprise and voluntary and community provision.18  Benefits accruing from economies of scale e.g. single not multiple teams, simplified access to services (including information and advice services), single IT system, commissioning/ buying power, single access points.  Enhanced commissioning and planning capacity to build successful strategies, plans and delivery capability linked to shared workforce alignment, capital investment and joint asset management. This will be supported by refined intelligence on demand and optimum interventions which could be applied in other settings.  Benefits accruing from integrated services, e.g. reduces the need/requirement for often expensive dialogues between organisations about who pays for/provides a service.  Benefits accruing from economies of flow – movement of work between services and around the system.  Benefits accruing from the right response made in a more timely way: reduced delayed discharges is a good measure for this benefit.  A more attractive business proposition for service providers in the future, such as social enterprise and shared local authority trading companies - e.g. services which in one authority are not a viable proposition become viable when three authorities are considered.  Reduced levels of inappropriate demand as a consequence of improved work flow, business processes and shared information.Non-financial benefits of the programme will include:  Achieving personal outcomes: Simplified system/ processes for customers – fewer boundary-related issues, better lives, more control, more choice and greater dignity  Reduced inequalities of outcome across our local populations  Enhanced staff outcomes: better jobs and job roles; improved productivity, morale and work satisfaction resulting from reducing the frustration associated with waste, blockages and crisis management which impact on their ability to help people; more development opportunities due to cross-agency delivery.  Political collaboration in this area can be applied in other areas of public service to achieve benefits for the whole population, and make the most efficient use of the “public pound”. Please refer to Section 4.3 which details these benefits, assigns objective measures to each, shows which benefits contribute to which of the eight outcomes described at19 the beginning of this section and shows which projects and initiatives of the programme deliver each benefit.20 1.3 Delivering the visionThe Better Together Programme The Dorset-area Partnership will consider several types of integration: functional; organisational; professional; and clinical. Integration will operate at macro (population wide); meso (for a care group); or micro (individual) levels. The breadth and degree of integration will also be considered, for example: horizontal integration which focuses on linking services that are on the same level of the process of healthcare. (which may involve competing or collaborating organisations, networks or groups); vertical integration bringing together different levels of care under one management umbrella, for example: drawing together hospital and community services. There will be several models across the system, rather than a model in which one size or one approach fits all. These aspects are recognised in our approach specifically in achieving change at the scale needed to make a difference. We will work at sufficient breadth and degree to affect individual and population outcomes. The programme will apply both horizontal or vertical integration at the same time: studies (eg: Nuffield) suggest that only focusing on one dimension could result in disruption between integrated primary and community services on the one hand, and vertically integrated care pathways (that take patients from first contact to specialist to ongoing care) on the other The new system will be based upon an approach which uses lead commissioning, draws on evidence from the 13 localities across Dorset, Poole and Bournemouth, recognises the benefits of horizontal and vertical integration and has a common understanding of the challenges, principles and ambition it is working to. The Dorset-area Partnership will progress integration based on evidence of what works nationally and locally. The development of integrated locality health and social care teams will be fundamental in addressing the increasing emergency attendances and admissions and supporting the work of the Dorset Urgent Care Board. The core components of the new system will be: f) Increasing the pace and scale of initiatives aiming to provide ‘care closer to home’ to achieve targets on shifting from institutional care to self-help and community based systems g) Developing whole-systems outcome-based commissioning to reflect best value. The range of outcome measures that would drive these commissioning intentions is described in Section 4.3. h) Developing new ways of working within and between agencies which aim to maximise and measure the added value of providing direct support to people who need help.21 i) Working with communities and individuals to help themselves by providing timely enabling interventions which reduce the need for crisis or longer-term statutory services. j) Informed by evidence of what works locally, nationally and internationally and from the experience of our populations and people who use our services when developing new approaches. The programme will deliver these core components within the next five years to be able to achieve a sustainable Health and Social Care system for the future. The high-level programme priorities reflect the immediate actions needed to improve service responsiveness and start to divert and manage the increasing demand for institutional and acute care. The longer-term objectives reflect the intention to re- commission services against a clearer set of whole-system outcomes which are delivered through integrated commissioning arrangements. The programme for integrated commissioning will include demand management, developing the new infrastructures for services and sharing market management, contracting and procurement responses. The focus on outcomes and the dependency of multiple providers to deliver the outcomes will require clear and transparent governance and a contracting approach that rewards collaboration and mutual support and does not allow providers (in extremis) to cause failure in others through any inadequacy. The commissioners will also allow providers time and scope to invest in service re-design, support for coordination (for example: integrated information systems) and drive continuous improvements. The Dorset-area Partnership and its commissioned delivery organisations will be administered efficiently and effectively to maximise the value of buildings and other assets. Based on earlier work on Total Place, and performance information, the programme recognises that current arrangements for financing the existing structure of services can and do work against delivering our ambition of achieving a person centred, co- ordinated system of health and social care, and the best use of resources. The new integrated commissioning model will test and then implement new financing tools which support rather than work against this ambition. These will include:  Shared financial planning by aligning and then, where it is needed, pooling budgets to support whole system working.  Use of an overarching framework or agreement for using pooled funds supported by specific schedules which can be added for agreed shared activity, thereby reducing the work associated with numerous separate agreements.22  Governance arrangements such as Health and Well-being Boards and shared joint scrutiny arrangements which recognise legal duties and accountabilities but also evaluate quality and value for money and reporting success against outcomes.  Chief Officer over-sight of the macro use of resources between partners to monitor the impacts and demand and changes across the health and social care system, supported by a common set of financial and performance information.  Investment in locality and community initiatives which seek to promote self help and divert demand. Leadership across the new system will be developed to drive the cultural change that is needed within and across agencies. This work will be supported by the LGA Systems Leadership Programme. It will develop the principles expected to be applied to their respective organisations. It will also evaluate and address cross- agency issues that are getting in the way of achieving an integrated service experience for the population. Front-line cultural change for multi-agency teams will get change working at the leadership and front-line level based on putting the individual first and practising the principles in the vision. Front-line teams will identify barriers to progress which will be raised as issues for the leadership or sponsor group. Within the programme, integrated ICT and more importantly shared business processes between the local authorities and health partners will be an essential enabler of joined-up working. This will include using the NHS number as a primary identifier and ensuring appropriate Information Governance controls are in place for information sharing. Customer focused approaches highlight the amount of duplication. The programme would seek to ‘baseline' waste or activity that adds no direct value to the person needing help and measure productivity. Dorset was a pilot for personal health budgets which was based on similar approaches used by local authorities for direct payments and personal budgets. The new models for commissioning will look to build on this to allow greater flexibility between agencies to meet needs – for example setting up individual pooled budgets.Implementing the changes The programme operates at the top of the eight partner organisations and provides an overall framework and co-ordination for the many initiatives (projects) that will drive change across the system. All the partners have a number of business and service reviews, transformational projects and business-as-usual developments 23 planned or already in progress. Many of these initiatives compliment or support the changes envisioned as part of the Better Together programme. There are also a number of key initiatives which are driven directly from the programme and are not part of any existing or local change. The programme is focused on the governance of all such change initiatives across the system, building the environment where the financial and non-financial benefits described in the previous section and in Section 4.3 can be realised. Individual projects will be delivered either within a partner organisation or coordinated across several partners.Projects within Better Together The Better Together programme encompasses a number of discrete but connected initiatives, some of which are individual projects, some as programmes in their own right. These are listed in the table below. Please refer to Appendix A for more detail on each of these projects and programmes.Table n – Programme and project descriptionsGroup Initiative: programmes & projects Description Programme management: PMO, three yearsMana Shared information and advice service - web- ging based information system Dema Shared advice and support services in the nd: acute hospitals Share d New self-funder support services - self Front financing -end Shared reablement model across Poole, Bournemouth and Dorset Independent Living services – DCs: Housing and equipment Mana URGENT CARE BOARD PROGRAMME ging • Emergency care pathways Dema nd: • Virtual ward - risk stratification Urge • Rapid response 7dpw nt • GP and out-of-hours services Care Boar • EOL care homes d • SPOR • Roll-out NHS111 • Intermediate care rapid response Impr Cultural & service change: customer-focus oving with specific cohorts 24 Group Initiative: programmes & projects DescriptionEffect Integrated processes for three LAs, implement ivene unified case management system ssInteg Develop shared commissioning across CCG ratio and the three LAs n of Market Management: attract new suppliers Com and stimulate economic growth missi oning Sector-wide workforce planning Integ Review of LA directly provided services rated Direc t Joint-commissioned multi-disciplinary teams Servic across 13 localities es multi-disciplinary teams joint use of capital assets Exter The Dorset Urgent Care Improvement Plan nal Progr amm Agency efficiency and Savings es Dorset, Bournemouth, & Poole Health & Wellbeing Strategies Corporate Plans and Priorities (3 LAs and CCG)TOTALSDelivering the benefits The programme is ‘benefits-led’, that is: it is focused on collating and managing the outputs from the various initiatives such that they collectively deliver benefit which in turn delivers the desired health, well-being, experiential and financial outcomes. The programme will include a management office, a major role of this is to track and report benefits and outcomes delivery and report progress into the governance layer for action. The role of the governance layer is principally to recommend adjustment, reinforcement or in extreme cases the stopping of projects according to their success within the wider picture of benefits delivery across the programme, and the resource cost to deliver.Risks and Issues There is a range of risks and some clear and present issues which will need to be managed or addressed. These are listed and in Section 6.2. Headline risks and issues are:25  Lack of continued political support for the programme from the leaderships of the three local authority signatories  Lack of continued support from the CCG/ NHS Trust Boards  Lack of organisational capacity to deliver full transformation  Rewards for investment in one area of the system are accrued in a different part of the system e.g. acute service benefits from investment (increased cost) in social care  Lack of adequate cultural change/ workforce planning to support transformation.Resources Across the eight partner organisations there is the financial and resource capacity to deliver this programme. Much of this will be workforce-led work supporting people undergoing change – training, new role definitions, compensation, change management and communications to staff and other supplier-end stakeholders. Health Education England is supporting the programme in this area The programme will require some additional specialist support. Much of this at the advice and consultation end of the spectrum will be forthcoming from DH and DCLG via the Public Service Transformation Network and other sources of assistance. There may be a need for specialist technical resource to support ICT and business process change, and to support the management of individual projects and the programme as a whole. See Section 6 for a more detailed assessment of the programmes resource capacity and capability.Stakeholders The programme has many stakeholders: people and (mainly) organisations that have a professional interest in its success. These include:  Service users, carers and wider public – the residents of the Dorset area  The governing bodies and executive of the eight partner organisations (the governing bodies of the three councils are the cabinets and elected members)  The Health and Wellbeing boards  The Urgent Care Board  NHS England26  Government – Department of Communities and Local Government, Department of Health, and Local Government Association  Staff working for one (or several) of the partner organisations  District and borough councils  Community and voluntary groups  Private health and care providers. A major part of the programme’s management office function (PMO) will be to establish communications and mechanisms to elicit and facilitate representation of the views and issues raised by stakeholders. This is supported by a separate communications and engagement strategy. 27 4.1 The Economic Plan – costs and benefits1.4 SummarySummarise outcomes and benefits v costs over five years. Include financial derivations of customer-oriented outcomes on the system. Include:  opportunities for innovation and/or collaboration with others.  risk quantification and sensitivity analysis  Cost of risk management / mitigation (c/f Delivery Plan)  Effect of changes in critical factors 1.5 Options and appraisalThe vision and aims of the programme have been described in Section 3, the Strategic Plan, based on the requirement that health and social care services across the Dorset area operate in a more integrated and customer-focused way, and where the focus is on prevention in the community to reduce need or demand for acute services. This serves to reduce cost overall and provide a more co-ordinated approach to services that promotes better health and well-being outcomes for the service-user or customer. The programme recognises that it will drive:  Co-ordination at the ‘front’ of the system – interacting with service-users, carers and patients  Integrated commissioning at the ‘back’ of the system – across the health and social care domains  Efficiency and effectiveness through the centre of the system – reducing costs and releasing resources, reducing elapsed times and enabling higher-quality and safer outcomes. The Partnership has considered how it would implement such a broad programme using external parties and has concluded that each of the partners needs to own and resource this programme of change which will have a substantial impact on the shape of each organisation and its interactions with the other partners. Within this broad outline there are many options around what detailed or specific initiatives are undertaken. Over the next three years it is likely that additional projects will be commissioned through the programme, and the possibility that some existing ones will be reviewed and decommissioned. Within each of these initiatives there will28 be a number of ways in which they can be delivered – scope and extent, internal and/or external suppliers, timeframes and resources. Options appraisals will need to occur at project-level to determine the optimum use of resources, probability of delivering the benefits and outcomes, and optimum risk profile. 1.6 Outcomes, financial benefits and input costsThe programme has defined eight broad outcomes that will be delivered as the system transforms through the projects and initiatives that make up the Better Together programme). These are: A. Total system costs reduced by 5% (of £1.2bn = a reduction of £60m) B. People have independence, choice and control C. Resources are used efficiently and effectively D. People are better able to help themselves E. Joint resource planning responds to need and local people’s priorities F. People experience better outcomes through safe, co-ordinated quality care G. Informal support maximised caring for people at home H. A capable, sustainable motivated workforceFinancial benefits A key outcome of the Better Together programme will be to reduce the operating cost of the whole health and social care system by five percent, as described above. This will be achieved through delivery of benefits realised from changes the programme will put in place across the system, resulting in reduced: demand or need at the front of the system; waste (inefficiency) through and across the processes, pathways and interventions; and prices for the services provided to users of the system. The programme will work with the DCLG and the LGA through the Public Services Transformation Network and through its existing involvement in the Systems Leadership programme to implement the transformation. One of the most challenging areas to address is financially assessing cross-agency benefits and measures in a way which is robust enough to form the basis for macro resource co- ordination and reallocation. The Public Service Transformation Network experience on developing and evaluating community budgets will be invaluable in developing the level of detail needed to provide sufficient agency confidence to release or move resources. Of particular interest is the learning from Manchester, West Cheshire and Essex on investment across boundaries and the technical development of cost-benefit models.29 The programme will draw upon technical expertise to analyse current demographic activity and financial data and then formulate baseline positions. The programme has established a cross-agency finance group that will be working with specialist advisors and technicians to generate cost-benefit models for the Chief Officer and Member Sponsors: spending patterns; fragmented high-cost interventions; the cost impacts of change. This cost- benefit analysis will be based on evidence but weighted to reflect accuracy assumptions (sensitivity analysis, optimism bias). The programme is undertaking complementary work with the LGA Systems Leadership programme to address the cultural issues that work across organisations and to build up the relationships needed to lead the changes. Benefits that will be explored and quantified during the early stages of the programme include: Enhanced market and local economic development arising from more opportunities to invest at scale in health and care private, social enterprise and voluntary and community provision.  Benefits accruing from economies of scale e.g. single not multiple teams, simplified access to services (including information and advice services), single IT system, commissioning/ buying power, single access points.  Enhanced commissioning and planning capacity to build successful strategies, plans and delivery capability linked to shared workforce alignment, capital investment and joint asset management. This will be supported by refined intelligence on demand and optimum interventions which could be applied in other settings.  Benefits accruing from integrated services, e.g. reduces the need/requirement for often expensive dialogues between organisations about who pays for/provides a service.  Benefits accruing from economies of flow – movement of work between services and around the system.  Benefits accruing from the right response made in a more timely way.  A more attractive business proposition for service providers in the future, such as social enterprise and shared local authority trading companies - e.g. services which in one authority are not a viable proposition become viable when three authorities are considered.  Reduced levels of inappropriate demand as a consequence of improved work flow, business processes and shared information.Work is underway between the partners to establish baseline positions on performance and the use of resources. The three councils undertook the ADASS 30 Use of Resources tool-kit self assessment exercise to assist with performance and efficiency issues. The information shows that councils are at different places across different measures, but work is needed to achieve an optimum balance of resources between community based provision (Communityland) and residential and nursing care (Careland). Best practice indicates a 30% expenditure in Careland provision against a current performance (2011-12) such as 57% for Dorset. Part of the macro overview of the new system by Chief Officers will include this expected shift of 20%. Similar macro resource measures are being explored within the health community to reflect best practice, for example the balance of expenditure between acute and community health care. Currently the Dorset area spends £484m, 53% of the CCG resource, on Acute Services and £94m, 10%, on Community Health Services £108m, 12% of the CCG resource, on mental health. There are a number of financial outcome measures that can assist the programme with the macro, meso and micro view of resource usage. These measures will form part of the system performance information for Chief Officers. They include:  Use of hospital resources: Delayed transfers of care from hospital, e.g. (ASCOF2C)9.  Non-elective length of stay and occupied bed days for >65s.  Emergency department attendances for >65s and emergency admissions for acute conditions that would not normally require hospital admissions (NHSOF3A)  Acute re-admissions within 30 days of discharge from hospital (NHSOF3.6) and proportion of older people who are still at home 91 days after discharge from hospital / into reablement /  Rehabilitation services (ASCOF2B / NHSOF3.6).  Proportion of people using social care who receive direct payments (ASCOF1C), and numbers of people receiving personal health budgets.  For use of residential and nursing home resources: Permanent admissions to residential and nursing homes, per 100,000 population (ASCOF2A).Input costs and financial benefits The table on the following page lists the key identified projects within the programme and an outline view of implementation costs (over three years, although many projects will take less time), and their expected contribution to the financial cost-base reduction target of 5% (£60m pa) over the whole system. An outline cost-benefit analysis follows the table31 The contribution of each project to the non-financial benefits and programme outcomes is described in the benefits dependency chart that follows this cost analysis.Group Initiative: programmes & projects Implementation Estimated system cost costs (3 yrs) reduction p.a (£k) (£k)Programme management: PMO, three years Direct project team costs 624 Commissioned support (eg: IPC) 100 748 Project software 9 Conferences 15Mana Shared information and advice service - web-based information system 175 ging Dema Shared advice and support services in the acute hospitals 200 nd: New self-funder support services - self financing 70 Share d Shared reablement model across Poole, Bournemouth and Dorset TBC Front -end Independent Living services – DCs: Housing and equipment TBCMana URGENT CARE BOARD PROGRAMME ging • Emergency care pathways Dema nd: • Virtual ward - risk stratification Urge nt • Rapid response 7dpw Care Boar • GP and out-of-hours services TBC d • EOL care homes• SPOR• Roll-out NHS111• Intermediate care rapid response Impr Cultural & service change: customer-focus with specific cohorts 250 oving Effect Develop integrated processes across three Local Authorities, and implement ivene unified case management systems 320 ssInteg Develop shared commissioning across CCG and 3 LAs ratio TBC n of Com Market Management: attract new suppliers and stimulate economic growth TBC missi Sector-wide workforce planning oning TBCInteg Review of LA directly provided services rated TBC Direc t Joint-commissioned multi-disciplinary teams across 13 localities TBC32 Group Initiative: programmes & projects Implementation Estimated system cost costs (3 yrs) reduction p.a (£k) (£k)Servic multi-disciplinary teams joint use of capital assets es TBCTOTALSCost-benefit analysisTo Follow:  Determine reduction in demand for acute and intensive/expensive services such as residential and nursing care, net of increased investment in preventative services and services delivered in the community  Determine improvement in efficiency as a consequence of a) integration of information across the system; b) improved end-to-end processes to manage clinical and community interventions; and, c) economies of scale through joint- working, and shared services and facilities;  Cost-benefit analysis workshop based on Tri-Borough work  Intended use for Integrated Locality model  Options appraisal for new commissioning structure.33 Benefits (financial and non-financial), linked to the projects in the programme The programme has defined the benefits it will deliver, and their measures, which together will deliver the outcomes desired by the Dorset-area Partnership. They are listed and described below. The tables that follow show the proposed measures for each benefit, the outcomes each benefit supports, and the projects within the programme that will deliver each benefit. The many-to-many relationship between the projects delivering benefits that create outcomes is shown as a benefits dependency diagram (fig n) at the end of this section.1. People can access and trust consistent, accurate information and advice 2. People can get co-ordinated help in arranging support 3. Avoid repeat use of services: minimise duplication and re-admission 4. Reduced need for hospital and high-cost services 5. Reduced avoidable emergency hospital admissions 6. Increased take-up and effectiveness of preventative and reablement services 7. Service enable people to live independently and well 8. Increased number of people being supported to live at home 9. Improved use of assets 10.Improved cost-effectiveness and reduced unit-cost of services 11.People are better supported in their caring role 12.Timely care and treatment 13.People are safeguarded and treated with dignity and respect 14.People experience a wide range of high-quality services 15.Services provide good value for money 16.Skilled, capable, flexible, integrated workforce34 Table n –Benefits and Outcomes Benefits contribute to one or more of the programme outcomes listed at the beginning of this section. The benefits will be delivered by the projects and programmes within Better Together. Outcome: A B C D E F G H Peopl Joint e resou exper rce Infor Peopl ience Resou plann mal A e Peopl bette Total rces ing suppo capab have e are r syste are respo rt le, indep bette outco m used nds maxi sustai ende r able mes costs effici to mised nable nce, to throu redu ently need caring motiv choic help gh ced and and for ated e and them safe, by 5% effect local peopl workf contr selves co- ively peopl e at orce ol ordin e’s home ated priori qualit ties # Benefit Measure y care People can access and trust consistent, ASCOF 3D 1 accurate information and advice √ √ √ √ People can get co-ordinated help in ASCOF 3D 2 arranging support √ √ √ √ NHS 3B, Avoid repeat use of services: minimise NHS 3.6, 3 duplication and re-admission √ √ ASCOF 2B ASCOF 2A, Reduced need for hospital and high- ASCOF 2A.2, 4 cost services √ √ NHS 3A Reduced avoidable emergency hospital Composite 5 admissions measure √ √ ASCOF 2B, Increased take-up and effectiveness of Activity Data: 6 preventative and reablement services √ √ √ √ Telecare Service enable people to live NHS 3.6 7 independently and well √ √ √ √ Activity Data: Increased number of people being Equipment; 8 supported to live at home √ √ √ √ √ DFGs Capital 9 Improved use of assets Population √ √ Equation Financial Improved cost-effectiveness and Returns 10 reduced unit-cost of services √ √ (PSSEX1) People are better supported in their ASCOF 1D 11 caring role √ √ √ √12 Timely care and treatment ASCOF 2C √ √ People are safeguarded and treated ASCOF 4A 13 with dignity and respect ASCOF 4B √ √35 Outcome: A B C D E F G H Peopl Joint e resou exper rce Infor Peopl ience Resou plann mal A e Peopl bette Total rces ing suppo capab have e are r syste are respo rt le, indep bette outco m used nds maxi sustai ende r able mes costs effici to mised nable nce, to throu redu ently need caring motiv choic help gh ced and and for ated e and them safe, by 5% effect local peopl workf contr selves co- ively peopl e at orce ol ordin e’s home ated priori qualit ties # Benefit Measure y carePeople experience a wide range of ASCOF 3A 14 high-quality services ASCOF 3B √ √ √ ASCOF 1C 15 Services provide good value for money (TBD) √ √ √ Skilled, capable, flexible, integrated 16 workforce (TBD) √ √ √ √Table n - Projects (or programmes) delivering benefits 36 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s Programme management: PMO, three years37 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s Ma Shared information and √ √ √ √ √ √ √38 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s nag advice service - web-based39 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s ing information system 40 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s De Shared advice and support √ √ √ √ √ √ √ √41 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s ma services in the acute 42 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s nd: hospitals 43 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s Sha New self-funder support √ √ √ √ √ √ √ √44 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s red services 45 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s Fro Shared reablement model √ √ √ √ √ √46 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s nt- across Poole, 47 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s en Bournemouth and Dorset 48 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s d Independent Living √ √ √ √ √ √49 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s services – DCs: Housing 50 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s and equipment 51 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects sMa URGENT CARE BOARD nag PROGRAMME52 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s Im Cultural & service change: √ √ √ √ √ √53 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s pro customer-focus with 54 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s vin specific cohorts 55 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s g Integrated processes for √ √ √ √ √ √56 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects sEff three LAs, unified case 57 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s ecti management system 58 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s ven59 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s ess60 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s Int Develop shared √ √ √ √ √ √61 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s egr commissioning across 62 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s ati CCG and the three LAs 63 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s on Market Management: √ √64 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s of attract new suppliers, 65 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects sCo stimulate economic 66 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s m growth 67 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s mis Sector-wide workforce √ √ √ √ √ √68 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s sio planning 69 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s nin70 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s g71 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s Int Review of LA directly √ √ √ √ √ √ √72 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s egr provided services 73 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s ate Joint-commissioned multi- √ √ √ √ √ √ √ √74 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s d disciplinary teams across 75 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects sDir 13 localities 76 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s ect multi-disciplinary teams √ √ √77 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects sSer joint use of capital assets 78 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s vic79 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s es80 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s81 Benefit (see Table n) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Pe A R R I S I I I P T P P S S opl v e e n e n m m e i e e e k P e o d d c r c p p o m o o r i e ca i u u r v r r r p e p p v l o n d c c e i e o o l l l l i l p get e e a c a v v e y e e c e l co- r d d s e s e e e d e or e e e d d a c a e s , din p n a d e d r a r x c ate e e v n u c e r e p p c a d a e o t a n s o e e r a n hel t d i a b u e s b s r o p p d k l m t e a a i v a a in u f a e e b o - t n f e i b c arr s o b - e f e t d e n d l c an e r l u p r f e g c e e e gin e p e a f r t u e , s g o h o o s e r a g s su f o e a p f s c s e r a o f pp s m n l e t u a d o l a ort s p e d e p t i p t e w d e n e i r e s v p m d i x d r t g e t o e o e d v i v a e f o p n r n a e a b t i l n f l e t t n l l r c c e l e s e d r u e u e a y c i s d a e , s s n t v b t n t : d h i e e a i r g f i o v i n n e e o n c m h s e i n d a r t o i i p n n g t t o e n n g i e d r h e f m g s i h t s e s e e d o r i m - a s p u d i h n a s i c l e p u r w i e t t s o o n p c i g y e e e s a f d o e c t h d n t d e r d a h - t d m p n t r q w , u s i r t e u i d u o p e s e l d n n i a r a l r s v y i g g l k c i v i e t t n i f c c i o n a o - r i t o u a c n t n c o t y r r t e s a d l o l y c a i s t i s e s e t o i w v t a e e n v e e n r e l o d v i a l a f i n n a t r c f d n s e e o d h e s s r r o r p m e r m v e a - e e i c Red items are mandated t a a c t i d b e BCF benefits. o m l s n i e s m a s e n i n d o t n a s d e v r i v c i e c Initiative: programmes & e Group projects s82 83 Fig n – the relationship between projects (or programmes), outputs or activity, benefits and programme outcomes.84 5.1 The Financial Plan – funding the programme1.7 AffordabilityThe principal funding for the Better Together programme will be through the Better Care Fund (BTF), formerly known as the Integration Transformation Fund (ITF). In addition, specific funds for specific initiatives are available. These are listed at the end of this section. Some of the work surrounding the establishment of new commissioning structures and commercial models, and changes to organisational structure, new roles and capabilities and ways of working will be funded from in-year operational budgets. However, ICT developments, new process design and new or re-designed facilities and accommodation will require additional funding. Additional resources or funding support for transformation from Government may become available during 2015-16 and onwards, and will be likely to be disbursed according to the success of NHS and council initiatives across the country. Funds to address specific elements or components of change, or particular cohorts of people may be available to the programme. There will be limited scope to re-invest efficiency savings (ie: budget surplus) that arise from reduced demand, efficiency savings and reduced service prices: the programme’s target of a 5% improvement in cost-efficiency will be enough to meet the projected reduction in funding (of Council’s and the NHS), and the increased demand that results from the increasing age-profile of the people of the Dorset area. Table n on page n gives an estimate of the implementation costs over five years and expected funding sources, across the projects and programmes within Better Together. It also shows where the programme expects a funding deficit, and how this can be rectified.Additional programme funding Funds are available to enable the start of programme, and to support elements such as programme management activities, specialist support, new ICT, and other build or change elements. Each Council and the CCG has provided £250k into the fund. Health Education England is providing a further £800k that will support preventative initiatives where there is a significant educational aspect to achieving success. Finally, the Transformation Challenge award has provided £750k to support the programme. Table n – funding (outside Better Care Fund)85 1.8 The Better Care FundThe Better Care Fund is a significant sum of money drawn from existing Government provision which will be distributed to councils and CCGs to enable integration between council and NHS services and the development of primary and community care solutions. It is not ‘new money ’, but rather a re-purposing and re-allocation of existing funds to drive transformation of the Health and Social Care system. Nationally, the fund will operate as follows:  £3.8 billion of funding in 2015/16 to be spent locally on health and care to drive closer integration and improve outcomes for patients and service users: o £1.9bn NHS funding o £1.9bn allocated across the health and wider care system: £130m carers’ breaks; £300m CCG reablement; £354 Capital (incl £220m Disabled Facilities Grant); £1.1bn transfer from health to social care  In 2014/15 an additional £200m transfer from the NHS to social care in addition to the £900m transfer already planned, In 2015/16 The fund will be allocated to local areas, where it will be put into pooled budgets under joint governance between CCGs and local authorities. Local Allocation – the Dorset-area Table n - Better Care Funding 2014-15 and 2015-16 BCF local allocation 2014/15 2015/16Overall £1.1bn Pooled NHS and LA Better Care Fund 2015- 16 Specific LA allocation Dorset County Council 8,870 27,227 Bournemouth Borough Council 4,051 12,028 Borough of Poole 2,922 10,169 Total 15,843 49,42486 CCG Baseline 15,843 49,424This is allocated across the three local authorities for each of the services listed in the following table.Table n – Better Care Fund distribution summary The June 2013 Spending Review agreed that £1bn of the £3.8bn would be linked to achieving outcomes: 50% of the pay-for-performance element will be paid at the beginning of 2015/16, contingent on the Health and Wellbeing Board adopting a plan that meets the national conditions by April 2014, and on the basis of 2014/15 performance. The remaining 50% will be paid in the second half of the year and could be based on in-year performance. Table n describes the mandated metrics and the date from which performance will be measured. The tables on the following pages describe:  The measurement period for each of performance targets required by the Better Care Fund (Table n); and,87  Better Together planned achievement against the Better Care Fund performance targets (Table n).Table n – Conditional funding measurement periods Metric April 2015 payment based October 2015 payment on performance in: based on performance in: Admissions to residential and care homes N/A Apr 2014 - Mar 2015 Effectiveness of reablement N/A Apr 2014 - Mar 2015 Delayed transfers of care Apr – Dec 2014 Jan - Jun 2015 Avoidable emergency admissions Apr – Sept 2014 Oct 2014 – Mar 2015 Patient / service user experience N/A Details TBC Dementia Diagnosis TBD TBDTargets for these measures have been established by the programme and will require agreement from Health & Wellbeing Boards and approval from Government (DH). The table below sets out the measures, current base-line and prospective targets for 2014/15 and 2015/16, and shows the target for the CCG as a whole, and for each of the three constituent local authorities.Table n – Conditional funding performance metricsThe Dorset-area Partnership’s submission for Better Care Fund (which this business plan underpins), requires a view of spend and financial benefit for each commissioning organisation of the Dorset area, over the next three years. Table n provides a high-level view of projected spend and benefit, the latter expressed as a reduction to that part of the system’s cost base for which the commissioning organisation is responsible88 Table n – Projected spend and financial benefits by commissioner, over time(£k) 2013/14 2013/14 2014/15 2014/15 2015/16 2015/16 Organisation spend benefits spend benefits spend benefitsLA Social Services (total): Borough of Poole Bournemouth Borough Council Dorset County Council CCG Primary Care Specialised commissioning Local Authority Public Health TotalIn addition to the achievement of the six outcomes (plus a ‘local’ outcome) listed in Table n, the Better Care Fund requires that a number of National Conditions are met. These are listed in Table n below, along with a brief statement of how the programme will meet these conditions.Better Care Fund - National Conditions There are six ‘National Conditions’: 1. Plans to be jointly agreed 2. Protection for social care services (not spending) 3. As part of agreed local plans, 7-day services in health and social care to support patients being discharged and prevent unnecessary admissions at weekends 4. Better data sharing between health and social care, based on the NHS number 5. Ensure a joint approach to assessments and care planning and ensure that, where funding is used for integrated packages of care, there will be an accountable professional 6. Agreement on the consequential impact of changes in the acute sector.The Dorset-area’s compliance with these conditions is described below:1. Plans to be jointly agreed89 The Dorset-area Partnership has developed a joint approach to delivering the required transformation of services across the system: the Better Together Programme. This programme has a single board representing all the organisations of the partnership, and will agree and drive the programmes and projects within Better Together. 2. Protecting Social Care Services Across the Dorset area we recognise that without change being made to the health and social care system, the increasing demands placed on our services as a result of financial pressure and demographic change will make those services unsustainable. Single agencies may be able to address waste in their own organisation through tactical re-design and continuous improvement initiatives, but to reduce the inefficiency and duplication that exists across organisations requires a transformational approach across the whole system. Our approach therefore to protecting social services is to utilise integration and early intervention to reshape activity and funding levels across the sector. The plans outlined within the Better Care Fund are intrinsically linked to the Dorset- area Partnership’s activity around transformation challenge "Better Together" and are focused towards expansion in the use of early intervention and reabling approaches to reduce on-going demand across the health and social care system. Activities within adult social care will become increasingly focused towards recovery, rehabilitation and reablement but with a clear recognition of the need for long term support for some customers in the most appropriate setting through the effective supply of residential and nursing provision. The local health and social care agencies have worked collaboratively to respond to the need to protect social care services not only in their own right but to the benefit of the whole health and social care system. For 2014/15 funding arrangements are in place as described within this template and business plan which can provide a high level of confidence in ensuring social care is protected. For 2015/16 the scale of change required across a significant number of services to release funds from health provision will prove challenging within the existing timeframe. This is set against significant budget reductions for Dorset, Bournemouth and Poole local authorities for this period. This is covered in the business plan. The impacts of the Care Bill are yet to be fully assessed but will form part of the local preparations for change. The level of additional national resourcing for these changes raises the risk to these extra duties and demands being fully funded locally. Poole is likely to have a higher than national average of people funding their own care which therefore increases this risk further.90 In summary for 2015/16 there is an aspiration and intention amongst the local partners to protect social care services but the risks are too high to provide an assurance.3. Seven-day services to support hospital discharge Seven day services are already supported through activities undertaken across health and social care but the plans within the Better Care Fund are designed to increase this level of activity further. Specific activities are highlighted to increase the ability to discharge into reablement and residential settings whilst also focusing resources towards improved early intervention. For example this can be demonstrated through commitments to increase Social Work cover in hospital settings over weekend period linked to enhanced access to care packages across the Pan Dorset area. The Better Together programme has a focus on jointly commissioning integrated health and social care teams, which will be available 7 days a week, with an initial focus on the frail elderly.4. Use of NHS Number across all services The NHS number is used extensively but not completely across the partnership. A key element of the Better Together programme will be to bring operational and customer case information together using NHS number as a key. The local authorities are in progress with the acquisition of a shared assessment and care management system: it is the intention to include ability to utilise NHS numbers within the specification for tender. The programme will develop an integrated information architecture across the partner organisations using open systems approach, and will develop a comprehensive and compliant approach to data security across systems and networks to enable this.5. Joint assessments and an accountable lead professional Risk stratification approaches are being used to identify the proportion of the population who will receive case management, have a lead accountable professional and personalised care plans, this is a key design principle of the integrated community teams.6. Acute Sector – Implications91 The Dorset-area Partnership intends through this plan to maintain activity within the Acute sector at or below the 13/14 baseline year plus population growth, and to reduce the length of stay for the frail elderly and those with multiple long term conditions. Holding the activity at these levels will be manageable for the Acute Sector organisations and release the funding necessary to invest in integrated service provision. This is intended to prevent, re-able and to allow pro-active case management of users, enable users to avoid admissions, speed up discharge and enable people to be cared for in their own homes, all of which serve to reduce demand on acute services If the investment in integration is not achieved or in part, this will create additional pressure within the Acute sector, especially in the winter months.Contingency Plans This section describes the contingency planning the Dorset-area has put in place to maintain operations if the expected financial benefits are not achieved. To follow: Table n – Contingency plansContingency plan: 2015/16 Ongoing Admissions to Planned savings (if targets fully achieved) residential and care homes Maximum support needed for other services (if Effectiveness of targets not achieved) reablement Delayed transfers of Planned savings (if targets fully achieved) care Maximum support needed for other services (if Avoidable emergency admissions targets not achieved) Planned savings (if targets fully achieved) Patient / service user Maximum support needed for other services (if experience targets not achieved) Admissions to Planned savings (if targets fully achieved) residential and care homes Maximum support needed for other services (if Effectiveness of targets not achieved) reablement Planned savings (if targets fully achieved) Delayed transfers of Maximum support needed for other services (if care targets not achieved)92 Table n – Stream costs and benefitsBetter Care Fund Investment (£k) 2014/15 2014/15 2015/16 2015/16 Dorset County Council spend benefits spend benefitsReablement 2,000 15,629 Integrated teams for the frail elderly and 6,869 99,926 people with long term conditions Integrated Community Mental Health Services 25,441 Integrated Community Learning Disability 45,082 Services Total 8,869 186,078Better Care Fund Investment (£k) 2014/15 2014/15 2015/16 2015/16 Borough of Poole spend benefits spend benefitsReablement 630 5,142 Integrated teams for the frail elderly and 2,122 29,465 people with long term conditions Integrated Community Mental Health Services 170 9,349 Integrated Community Learning Disability 11,848 Services Total 2,922 55,804Better Care Fund Investment (£k) 2014/15 2014/15 2015/16 2015/16 Bournemouth Borough Council spend benefits spend benefitsReablement 275 5,972 Integrated teams for the frail elderly and 3,567 26,185 people with long term conditions Integrated Community Mental Health Services 210 12,413 Integrated Community Learning Disability 17,436 Services93 Total 4,052 62,0061.9 Funding the Better Together ProgrammeThe Better Together transformation programme will execute through a series of initiatives – programmes within the Better Together programme, and stand-alone projects, as described in Section 3.3 of this Business Plan. Each initiative will require investment to deliver the change, and in some cases annual investment to run the new service, facility or element of the system as ‘business as usual’ Table n below lists each initiative in the Better Together programme along with a view of required funds and sources, and whether there is (currently) a funding deficit.Table n – Programme and project funding and funding sourcesYears 1 – 3 (2014-15 to 2016-17) Funds Funding sources Allocated Funding required funds deficit Group Initiative: programmes & projects £k £k £k Programme management: PMO, three years Man Shared information and advice service - aging web-based information system Dem Shared advice and support services in the and: acute hospitals Shar ed New self-funder support services Front Shared reablement model across Poole, -end Bournemouth and Dorset Independent Living services – DCs: Housing and equipment 94 Years 1 – 3 (2014-15 to 2016-17) Funds Funding sources Allocated Funding required funds deficit Group Initiative: programmes & projects £k £k £kMan URGENT CARE BOARD PROGRAMME aging • Emergency care pathways Dem and: • Virtual ward - risk stratification Urge • Rapid response 7dpw nt • GP and out-of-hours services Care Boar • EOL care homes d • SPOR • Roll-out NHS111 • Intermediate care rapid response Impr Cultural & service change: customer-focus oving with specific cohorts Effec Integrated processes for three LAs, tiven unified case management system essInteg Develop shared commissioning across CCG ratio and the three LAs n of Market Management: attract new suppliers Com and stimulate economic growth missi onin Sector-wide workforce planning gInteg Review of LA directly provided services rated Direc Joint-commissioned multi-disciplinary t teams across 13 localities Servi multi-disciplinary teams joint use of capital ces assets TOTALS6.1 The Delivery Plan – executing the business plan1.10 The programmeThe Better Together programme is a co-ordinated set of programmes and projects. Some of these have been defined specifically as part of the Better Together collaboration across the eight partners; some originate in other cross-agency initiatives (for example the Urgent Care Programme) and some that are existing or planned initiatives in individual agencies. Together they will implement a re-design of transformation of the system – a new operating model – that will deliver the benefits and achieve the desired outcomes.95 The principal challenge – which all partners recognise – is that of aligning the programme with the needs and interests of the eight agencies: while there is much common interest in transforming the system – funding, contact, process, etc, there is also the reality of moving large organisations towards a joint goal – a difficult challenge which succeeds or fails on the capability of the programme to keep the majority of interests aligned over the next three years. Stakeholder management and strong inclusive governance will be key enablers. 1.11 Programme and project managementGovernance The main governing body for the programme is the Better Together Programme board, comprised of senior members (normally direct reports to their respective CEOs) of the eight principal agencies. This board directs, co-ordinates and moderates the activities of a number of subsidiary boards (for example the Shared ICT project board) while controlling some larger projects directly. It has the following characteristics:  The Better Together Programme Board is placed at the heart of the programme’s governance structure.  The board receives its authority from the Sponsoring Board which represents the partner organisations through their executives.  Political leadership and influence exists through the Health & Wellbeing Boards and Local Authority Cabinets, and hence the Programme Board via established cabinet-based democratic mechanisms present in each local authority and their NHS Board equivalents.  The necessary overview and scrutiny function is also discharged through established local authority processes via the political leadership and the executive of the partner organisations.  The programme has higher-level partners which have an advisory and influencing relationship through the Programme Board: the LGA Systems Leadership Development Programme; the DCLG Transformation Network, and the Urgent Care Board.  The Board is supported in its work and decision-making through the Programme Management Office, the Finance Sub-Group, and the Workforce and Organisational Development Group. A series of Project Boards oversee the development and implementation the projects that make up the Better Together Programme. These are grouped initially into four ‘sub-programmes’: 96  Integrated Front-end Services;  Joint Commissioning;  Integrated Locality Teams; and,  Local Authority Directly Provided Services. The relationship between boards and projects is described in Fig n, belowFig n – Better Together governance diagramEach sub-programme and project within Better Together will have its own project board constituted according to discipline and which agencies are involved in the project. In some cases there will be a lead agency and that will be reflected in the project board’s composition. Each project will have its own charter and terms of reference within the ‘project initiation document’ and will be monitored on its benefits. These documents will provide the programme with the means for approving and overseeing the progress of each project.Partner resources Dorset County Council will provide: the Senior Responsible Owner, Programme Manager, Programme Support, Programme Accountant, Configuration management and administrative support, and Strategic Communications. DCC will also coordinate multi agency Finance, Human Resources and Legal sub-groups. Each of the partner organisations will provide: Business Change Managers for the Programme Board; User, Supplier, and subject matter expert representation for individual component projects within the programme as required. The DCLG Transformation Network will provide: Subject matter support and expertise as required. The Local Government Association will provide: 20 days of expert consultancy to support systems leadership development across the eight partner organisationPlease refer to Appendix B for the Better Together Programme Brief and an outline Programme Charter and Policies.97 Operations management The programme has a dedicate management structure consisting of:  Programme Director  Programme Manager  Programme Management Office (PMO) Manager  Design Authority for target operating model, ICT, process design and joint- working  PMO benefits realisation resources  PMO communications resources  PMO administration resources: o Budget management o Procurement/ resource acquisition o Scheduling o Reporting – projects and programme The PMO will utilise IT collaboration systems to provide unified communications and reporting capability across the projects that make up the programme. The diagram in Fig n, below, describes the programme management structure.98 Risk management Risks will be managed and issues resolved at all levels of the programme, and will escalate through work-stream, project, sub-programme and Better Together programme boards. Risk management will focus on three main areas – achieving benefits, delivery costs, and stress-risk to the organisation(s) and system as a whole. Mitigation (or resolution of the issue, should the risk become manifest) will be directed by the appropriate management or board, and reported or escalated as appropriate. The Better Together board is at the centre – risks and issues that cannot be resolved here will require a special report to the sponsors – the CEOs of each of the eight partner organisations for resolution at the Sponsors Group. The current high-level risks and issues relating to the Better Together programme are listed in Table n, below.Table n – Risks and issuesLike RA Typ Imp # liho G Risk Impact Management e act od Effective allocation of Budget pressure resources on a proportionate Continued pressure across the sector basis through the Better Care Prof CCG upon community Maj Poss resulting in a loss of Fund and the creation of close essi 12 care and acute or ible 1 ability to invest in links to the Pan Dorset sector onal preventative services. transformation challenge arrangements. Transformation Urgent Care Board projects funding diverted to are currently being undertaken support acute Continued pressure to reduce pressure upon acute sector ‘business as Prof CCG upon discharge and settings and these are being Maj Poss usual’, leading to essi 12 emergency managed through clear or ible 2 reduced admissions governance arrangements to onal transformation of share good practice and system and address issues as they arise. reduced benefits Inspection findings Addressed through in acute and partnership working Inspection outcomes community settings arrangements and sound Prof Mod CCG within acute and Poss could shift focus governance linked to the essi erat 9 community based ible 3 towards highlighted Urgent Care Board and the health settings onal e concerns as a "Better Together" Programme higher priority. Board. Clearly defined, explicit, and Confusion, delay, universally agreed scope Prof Mod Danger of "scope Likel 1 disengagement of described in the programme plan essi erat 12 creep" y stakeholders Ongoing monitoring and hands- onal e on sponsor board action99 Like RA Typ Imp # liho G Risk Impact Management e act od Sign up at early stages by all key Programme will have stakeholders; buy-in at senior Lack of Chief Officer to be reshaped to level; facilitated system support/leadership account for it. leadership development Polit Maj Poss 2 12 across one or more Programme programme ical or ible key stakeholders weakened and Good communication throughout susceptible to failure the programme; transparent process Communication with all political stakeholders through CEOs; Could result in the Lack of ongoing political briefings Polit Maj Poss 3 withdrawal of one or 12 ical or ible political support more stakeholders Ongoing communication / political briefings and engagement Agreed methodology at the start through agreement of the Disagreement of Distraction from Part programme and initial Maj Poss 4 approach/ achieving end results; ners 12 programme documentation or ible methodology builds in delay hip Ongoing monitoring and hands- on sponsor board actionPolitical / Stakeholder Mismatch between wider Cust decisions out-of-line Maj Poss 5 stakeholder/public Engage stakeholder group; study ome 12 or ible with public needs and end and understand customer r expectations/mood product demand Programme seen as an "add on" to Senior leadership commitment normal business Poorly constructed Senior leadership to ensure that Part Mod Poss 6 therefore given programme; delays; the programme is factored in to ners erat 9 ongoing transformation ible insufficient priority by diverts resources hip e programmes within own one or more organisations stakeholdersUrgent savings needs Savings opportunities Part within a single agency missed; implications Maj Likel 7 Focus on end prize; stakeholders ners 16 for stakeholder or y impacts on delivery of to manage within existing hip the programme engagement resource Clear and timely communication with staff Staff and unions do Ongoing clear and timely Mod Hampers progress; Staff Poss 8 not support the communications; development of erat 9 delay communication strategy and ing ible proposals e plan; set clear conditions from the outset; engage staff and unions early on Adapt; take steps to minimise Change of national Aspirations become impact; horizon scanning; Legis policy / legislation watered down; Maj Unli 9 maximise the involvement of the lativ 8 benefits not or kely adversely affects the Public Sector Transformation e maximised programme vision Network100 Like RA Typ Imp # liho G Risk Impact Management e act od Key staff change, Design resilience into the Prof Mod leave or are absent Programme Poss 10 programme development team; essi erat 9 hampered / delayed ible for a prolonged identify deputies for key roles onal e period Resource commitment / Agreed system-wide business plan investment not Programme falls Fina Maj Poss 11 forthcoming or short of achieving Be clear from the outset about 12 the level of investment/resource ncial or ible insufficient for the tangible benefit required; clear business cases for level of change initiatives within the programme required Rewards for investment in one Investment reduced area of the system Strong business case and plan; or not forthcoming; are accrued in a engage all major stakeholders; Prof continue to do the Maj Poss 12 different part of the view as a single system - essi 12 wrong thing from the or ible understand systemic impact; onal system - eg acute customers effective cost benefit analysis service benefits from perspective investment (increased cost) in social care) Builds in waste, Benefits to the Focus on customer during any failure and cost into Cust Cata customer and programme change or planned Poss 13 services; negatively ome stro 15 improvements; do work around ible organisations are not impacts the desired r phic the voice of the customer achieved benefits Transformational One or more Challenge programme organisations shift Commitment from partner contradicts or priorities or become organisations unable/unwilling to Part conflicts with existing Maj Poss 14 participate; change Identify other organisational ners 12 or ible change programmes of focus away from priorities and interdependencies hip and priorities in one transformational at the detailed programme or more partner challenge priority planning stage agencies areas Dispute amongst Poorly constructed partner agencies; Maximise the support and formal partnerships damage to experience of the Public Sector Legis Maj Unli 15 resulting in illegal reputation of Transformation Network; engage lativ 8 or kely arrangements and partners; increased with legal subject matter experts e increased liabilities costs; aborted at an early stage programme work Fines imposed by Engage with legal subject matter Data Commissioner; Legis Breach of data experts at an early stage; ensure Maj Poss 16 customer personal lativ 12 data sharing responsibilities are or ible protection data compromised; e clearly defined reputational damage 17 Lack of alignment of Programme Ensure programme joint Part Min Likel 8 decision making hampered / delayed governance structures are fit for ners or y cycles results in purpose hip delays to programme 101 Like RA Typ Imp # liho G Risk Impact Management e act od timescalesInability to achieve Effective cost benefit analysis, Cata savings & reduction in Future budget Fina Poss 18 financial monitoring and stro 15 demand pressures ncial ible contingency planning phicOngoing ownership and Incompatibility of ICT Ineffective data monitoring by ICT work-stream; Tech Mod systems for sharing build flexibility in to individual Likel 19 nolo erat 12 programme activities; prioritise y programme Failure to realise gical e implementations benefits the development of common business processes Inadequate Priority of programme clearly programme support Prof Mod Hampers progress; defined Unli 20 functions (i.e. HR; essi erat 6 delay Early engagement with corporate kely procurement; legal; onal e support functions accountancy)Competition / Right Com Mod Delay in programme Horizon scanning; early Unli 21 to Challenge diverts petit erat 6 delivery engagement with legal kely programme goals ive e22 Failure to maximise Early engagement and Part Maj Unli the contribution of Less effective use of involvement, ensuring that they ners or kely 8 the voluntary & community services have input to programme hip community sector objectives and developments Inability to deliver Lack of cultural Targeted workforce development changes required and Staff Maj Poss 23 change/workforce programme work-stream, with 12 implement new ways ing or ible consultancy support. planning of working Business plan. Some funding with- Failure to meet BCF Actions to refer spec to Fina Maj Poss 24 held, and/or reduced 12 conditions. ncial or ible conditions local control Financial monitoringBenefits delivery Better Together is benefits-led. Governance and programme management is focused on three key elements, in order: 1. Benefits delivery and their measurement against existing baselines 2. Risk mitigation and issue resolution 3. Alignment of the partner agencies to the overall system architecture102 The tables in Section 4 describe how the projects and sub-programmes deliver benefits which in turn realise the programme outcomes, and the measures the programme will use. Reporting mechanisms and management activities are aligned to this approach, enabling the programme to track and intervene where necessary to support or re-align projects to enable benefits and outcomes delivery. The diagram in Fig n, below, illustrates how this will work.Fig n – benefits management approachDiagram to follow1.12 Capability and CapacityTimeframes Timescales v project activity and change pressures, plus maintaining BAU. ‘Heat-map’ chart of programme resources (people, skills, financial) over time (1 page) This section to completeCapability & Capacity Describe capability and capacity across the Partnership, its sufficiency to implement the programme successfully and how any additional capability or capacity can be acquired and funded for: Programme and project management, benefits management Service re-design – operating models, roles and capabilities, information and process management Change management, HR, training & development Stakeholder management – across and within the eight Partner organisationsThis section to complete103 Fig n – High-level programme timelineBetter Together: Business Plan v0.1 05/01/2014 104 Better Together: Business Plan v0.1 05/01/2014 105 AppendicesBetter Together: Business Plan v0.1 05/01/2014 106 Appendix A: Table of ProjectsThe key details of each project are described in the table-list below. Note that implementation costs have been estimated for the project across a number of categories, and that benefits (H,M,L) are linked to the numbered benefits at Table n in the main document. The risk RAGs under benefit delivery and implementation cost indicate how stable the project is in terms of achieving the benefits within project budget.# Project title Part of (group) Reports to (board) colour SRO: Start date End date Description: Benefits: Costs: 1 Design 2 Change 3 Facilities 4 People 5 ICT Delivery Resources: 6 Other Risk: Risk:# Project title Part of (group) Reports to (board) colour SRO: Start date End date Description: Benefits: Costs: 1 Design 2 Change 3 Facilities 4 People 5 ICT Delivery Resources: 6 Other Risk: Risk:Better Together: Business Plan v0.1 05/01/2014 107 # Project title Part of (group) Reports to (board) colour SRO: Start date End date Description: Benefits: Costs: 1 Design 2 Change 3 Facilities 4 People 5 ICT Delivery Resources: 6 Other Risk: Risk:# Project title Part of (group) Reports to (board) colour SRO: Start date End date Description: Benefits: Costs: 1 Design 2 Change 3 Facilities 4 People 5 ICT Delivery Resources: 6 Other Risk: Risk:# Project title Part of (group) Reports to (board) colour SRO: Start date End date Description: Benefits: Costs: 1 Design 2 ChangeBetter Together: Business Plan v0.1 05/01/2014 108 3 Facilities 4 People 5 ICT Delivery Resources: 6 Other Risk: Risk:Appendix B: Benefits measuresBetter Together: Business Plan v0.1 05/01/2014 109 Better Together: Business Plan v0.1 05/01/2014 110

Transforming the Health and Social Care System Across the Dorset Area

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