GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN Greater Manchester Health and Social Care Devolution Locality Plan for Salford August 2017 1 GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN CONTENTS 1 STRATEGY AND OUTCOMES Page NOTES TO THIS VERSION 3 EXECUTIVE SUMMARY 5 KEY TERMS – Glossary 15 1.1 INTRODUCTION – PURPOSE 16 1.2 LOCAL CONTEXT 17 1.3 PARTNERS IN THIS LOCALITY PLAN 19 1.4 METHODOLOGY 20 1.5 RATIONALE – the case for change 21 1.6 VISION AND OUTCOMES 24 1.7 TIMESCALES FOR CHANGE 25 1.8 SETTING OUT OUR AMBITION 26 1.9 OUTCOME MEASURES 27 2 THE LIFE COURSE 2.1 STARTING WELL 30 2.2 LIVING WELL 35 2.3 AGEING WELL 39 3 TRANSFORMATION 3.1 OUR TRANSFORMATION PRIORITIES 43 3.2 DRIVING CHANGE 46 3.3 ENABLING TRANSFORMATION 50 Standardisation of clinical support and back office functions Enabling better care 3.4 PREVENTION 62 Upgrading population health, prevention and self-care 3.5 BETTER CARE 77 Transformation of community based care and support Standardisation of acute and specialist care 4 GOVERNANCE and FINANCE 4.1 GOVERNANCE 95 4.2 PERFORMANCE REPORTING ARRANGEMENTS 96 4.3 GM GOVERNANCE ARRANGEMENTS 96 4.4 FINANCIAL PLAN 98 4.5 MANAGING RISK LIST OF APPENDICES AND SUPPORTING PAPERS 106 2 GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN NOTES TO THIS VERSION August 2017 This document is a living and breathing blueprint for change and is intended to be reviewed on a periodic basis. The following issues should be noted whilst reading this Plan: This version has been prepared to accompany Salford’s applications into the 2016/17 Transformation Fund. The Financial Plan has been updated in the light of roll up of the financial planning across all partner organisations. The Greater Manchester (GM) Health and Social Care Devolution Team has considered the robustness and alignment of Locality Plans against the GM Strategic Plan. The initial assessment which has been carried out by the GM team has shown Salford to be in a strong position. Further work which was required around the Implementation Plan, financial alignment and return on investment has now been incorporated within this version. We have strongly articulated the year 1 (2016/17) priorities for Transformation Funding in Salford, all of which are ready to commence delivery. Over the coming months, we will work to further develop propositions for further investment over the 5 year period of the Plan. We are currently reviewing the implications of the Locality Plan on the governance arrangements surrounding the Health and Wellbeing Board and across the system as a whole. Section 4.1 of the Plan may require review in the light of this work. The Implementation Plan for the Locality Plan is in preparation and forms Appendix 6 to this Plan. Salford’s Health and Wellbeing Board has asked that the financial, clinical and other risks associated with delivery of the Locality Plan should be identified and assessed. Information on risk appetite, assessment and management has been included in a new section at 4.5. a strategic risk register has been added at Appendix 13. Further work is ongoing to set aspirations for the indicators stated in section 1.9, and align these aspirations with those stated in the GM Strategic Plan. 3 GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN An ongoing part of the development of this Locality Plan has been engagement of stakeholders – partners, service users, patients and wider citizens. However, although there has been provider engagement through members of the Health and Wellbeing Board, including with the voluntary, community and social enterprise sector, it is recognised that further discussion will be required with a wider group of providers of services in the City. A Communications, Engagement & Social Marketing Strategy has been endorsed by the Health and Wellbeing Board at its meeting in May 2016 (see Appendix 8) A Community Impact Assessment (CIA) is taking place, using the City Council’s arrangements for assessing impact of the Plan in the 9 protected groups under the Equalities Act. The final draft is now available at Appendix 7 and will be published in the near future. Whilst acknowledging the large number of activities which are still happening around the Locality Plan, the narrative which it contains around our shared Vision and Outcomes for health and wellbeing in Salford; the life course approach; and transformation objectives, have all been endorsed by Salford’s Health and Wellbeing Board following its meeting in March 2016. The Health and Wellbeing Board has clearly stated that it recognises the need for ongoing review of Salford’s Locality Plan. This will now take place on a quarterly basis throughout 2016/17, with revised versions being published as required. Salford’s Locality Plan was approved by the Health and Wellbeing Board at its meeting in March 2016. 4 GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN EXECUTIVE SUMMARY "We are not tinkers who merely patch and mend what is broken... we must be watchmen, guardians of the life and the health of our generation, so that stronger and more able generations may come after" Dr Elizabeth Blackwell (1821-1910), The First Woman Doctor Salford’s Locality Plan articulates our vision over the next five years for the improvement of wellbeing, health and care outcomes for residents in the city, across a timescale of short, medium and longer term impacts. The Plan sets out specific programmes and objectives which are in place to deliver against that vision, using a life course approach (Starting Well, Living Well, and Aging Well). It also reflects the need to tackle the demographic, financial and clinical challenges facing the city. We have a clear, shared understanding of the desired relationship with the people of Salford. This is no longer primarily about delivering services (except for acute and emergency situations), but recognising that most of the solutions lie within the people: a long-term journey towards a “strong, living system” for which there is a lot to do to prepare both the professional system and its leaders, and indeed local people and communities. Building carefully defined relationships across all sectors will be vital to having a truly transformational plan. Salford’s population is growing. The number of households in the city has increased by 10% over the last ten years and is forecast to increase further. It is also a city of economic growth; with nearly £2bn inward investment over the last 5 years creating over 5,000 jobs, encouraging new businesses, building new homes and developing the city's education and health services. Salford has a strong and vibrant Voluntary, Community and Social Enterprise sector (VCSE), which is a core partner in the city’s economic and social offer, as well as in this Plan. The changing environment and demographics bring a new challenge to Salford to provide sufficient and appropriate services for a population that, whilst improving overall, still suffers significant deprivation in parts of the city. Around 70% of Salford’s population live in areas classified as highly deprived and disadvantaged, and around 12,300 children in the city live in poverty. There is a challenge to narrow the gap between Salford and the rest of England in terms of access to opportunities, education, employment, health and wellbeing; as well as within Salford where there is a huge diversity in social and economic outcomes which exists between neighbourhoods. This Locality Plan aims to address these inequalities and connect people to opportunity through inclusive growth. Furthermore, Salford’s residents experience health and wellbeing that is worse than the national average and people in the city are likely to die earlier than England as a whole. Reducing the numbers of people in Salford affected by the ‘biggest killers’ of cardiovascular disease, cancer and respiratory disease remains our biggest challenge. This means helping to prevent people from becoming ill in the first place, by focussing efforts not only on addressing the key lifestyle risks that cause these diseases i.e. smoking, excessive alcohol 5 GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN intake, physical inactivity and poor diet, but also on the ‘causes of these causes’ including housing, physical environment and employment situation. Our Plan describes a Vision for the people of Salford, supported by a number of Strategic and Delivery Principles. It goes on to describe target outcomes across the life course, which will be delivered by a programme of transformational initiatives spearheaded by our ongoing Vanguard work around integration of commissioning and provision of care, place-based approach to service provision which builds on the strengths and assets already in place in our communities, the transformation of Acute Care services in collaboration with Wigan, and the Salford Standard in Primary Care, as well as established programmes around workforce development, use of digital technology and social value in commissioning. VISION: Salford people will start, live and age well - People in Salford will get the best start in life, will go on to have a fulfilling and productive adulthood, will be able to manage their health well into their older age and die in a dignified manner in a setting of their choosing. People across Salford will experience health on a parallel with the current “best” in Greater Manchester (GM), and the gaps between communities will be narrower than they have ever been before. The current public sector financial pressures are significant. Our aim is to achieve the required level of savings in a way that has the least impact on achieving our vision for Salford. This will require transformation of services and significant changes in the way care is provided and accessed, collaboration across partner organisations (and with new partners), and challenging conversations about shared priorities as well as the services that will need to cease.