The Oldham Locality Plan for

Health and Social Care

Transformation

April 2016-March 2021

Executive Summary

  1. Purpose of the Oldham Locality Plan

Our Locality Plan sets out how we will transform health and social care in Oldham to meet our triple aims of delivering improved health and wellbeing for the people of Oldham, clinical sustainability, and financial sustainability.

  1. Context

In Oldham, the partners share an ambition to see the greatest and fastest possible improvement in the health and wellbeing of our residents by 2020. However, our drive to improve health comes at a time when, across Greater Manchester, there are significant financial pressures that pose a threat to the health and social care system.

There is a predicted financial gap for health and social care commissioners (CCG and Council) by 2020/21 of £123m. We can reduce this to £26.9m if all current interventions, including protection of adult social care funding, planned 2016/17 council budget reductions, planned CCG savings and additional NHS funding over the five years to 2020/21, are implemented.

Achieving our ambitions for health, whilst simultaneously producing the level of savings described above, will require a radical shift in the way services are shaped and operate. We have to commit and change the whole system so that it is geared towards keeping people healthy and in control of their lives.

  1. Devolution

The Greater Manchester Health and Social Care Devolution Agreement promotes the development of an integrated health and social care strategy and the pooling of budgets across GM to reduce the pressure on A&E and avoid hospital stays. Where it makes sense to, a number of workstreams are being delivered at the Greater Manchester level as part of this strategy, including development of a mental health strategy and Public Sector Reform.

In turn, each of the ten local authorities has developed a Locality Plan, aligned to the GM strategy, whichidentifies the actions that will be delivered at the local level to transform health and social care.

In Oldham, preparing for devolution has accelerated the establishment of new ways of working across health and social care. Our Locality Plan is underpinned by the idea that our health and social care services will operate in a system for the place of Oldhamrather than within organisational boundaries. Adopting this system approach has:

  • Enabled commissioners and providers to identify the shared drivers of demand on services e.g. changes to the population;
  • Brought forward plans to widen the scope of pooled budgets;
  • Enabled us to start to map all our programmes and interventions in a single place and to look at how we jointly plan programmes, define and share outcomes, and share project management tools in the future;
  • Enabled us to look jointly at our system dependencies so that in future we can minimise the risk that changes to one part of the system inadvertently put pressure on another.
  1. The Oldham Locality Plan

Here in Oldham, our health and social care system will be geared towards wellbeing and the prevention of ill health, self-care, access to health services at home and in the community, and social care that works with health, community and voluntary services,and the social housing sector to support people to look after themselves and each other.

The Locality Plan outlines how we need to adopt ways of working and models of care that boost people’s sense of control, capability and independence so that we can promote health and reduce poverty and inequality. Our public services will work with partners and with Oldham’s communities to help build resilience, ensure every child has the best start in life and ensure that all of Oldham’s residents are able to maintain the highest levels of mental and physical wellbeing.

Weneed to equip people to manage existing health conditions themselves whilst ensuring that a strong and patient-focussed Oldham health and social care system, centred around primary and community-based care, is there for those people who require support.

Such transformational change is required to achieve the improvement in health and wellbeing that will mean people in Oldham and Greater Manchester are happier and less dependent on public services, and that the demands on such services are reduced to the point where a more efficient and effective health and social care system is able to provide the best treatment and care and stay in financial balance.

There are six principles that underpin our Locality Plan and that will support the way we work with our key stakeholders across Oldham to deliver it:

  1. The deployment of resources flexibly and enabling professionals to do the right thing to achieve shared aims and objectives. This will include integrating delivery and pooling NHS and local government resources where it makes sense, and a closer relationship and different contracting arrangements between commissioners and providers;
  2. A commitment to taking a whole system approach to health and social care in Oldham and across Greater Manchester, with a jointly owned model of inclusive governance and decision-making across commissioners, providers, patients, carers and the housing, voluntary, community and faith sectors;
  3. A new relationship in Oldham between public services and citizens, communities and businesses that supports genuine co-production, the joint delivery of services, and a reduction in demand - “Do with, not to”;
  4. A focus on the lifecourse, prevention and the most disadvantaged, and a commitment to promote and use asset-based approaches that recognise and build on the strengths of individuals, families and our communities rather than focussing on the deficits;
  5. The Council and the CCG being responsible and striving to support innovation, reduce unwarranted interventions and admissions, reduce costs and improve productivity to get the best value possible and achieve financial sustainability without compromising the safety and quality of treatment and care;
  6. Partners across Oldham working with each other to ensure that all resources are used to the best effect to meet the needs of and to benefit the whole of Oldham’s civil society and financial economy. This will include taking account of the national and international evidence and best practice.
  1. Our four transformational programmes

Our Locality Plan sets out four transformative programmes that will have a significant impact on health across the lifecourse:

  • Living Well - Action to build resilient communities and provide early help;
  • Starting Well - Early years, children & young people;
  • Mental health is central to good health;
  • Establishing an Accountable Care Management Organisation.

There are many other initiatives, programmes and clinical models of care being delivered for and with people in Oldham on a day-to-day basis that influence wellbeing and health, both within and beyond the health and social care economy. These will continue.

The focus on four key areas will help us to establish the place-based whole system approach to commissioning and provision of services that we will adopt for all existing and new programmes across Oldham in the coming months and years.

The four programmes selected are transformational as we believe that they are the key ones to drive improvement in health and wellbeing and high quality service provision.

The programme of work on community resiliencewill support communities to get a greater sense of control over their lives and engage in activity that develops connections within and between communities. Services that support people before they get into complex and long lasting problems will reduce demand on the services that are needed when people are in crisis.

The early years and young people’s workwill support the best start in life that is crucial for all children in Oldham and mean that more children are ready to start school and take advantage of those learning opportunities from a supportive home environment.

The work on mental healthwill recognise that having good mental health is essential for every aspect of overall health and for people and communities to thrive. The programme will address how communities in Oldham talk about mental illness, support each other through mental illness and access high quality treatment and care services.

The work to set up an Accountable Care Management Organisationwill mean that a big step will be taken towards a truly primary- and community-based health and social care service that provides timely and effective support for people in Oldham if and when it is needed.

How the programmes fit together across the lifecourse and how they strike the balance between action to support individuals and action to promote community wellbeing is shown in Figure 1 below.

Figure 1: Oldham’s four transformational programmes

  1. Implementation of the Locality Plan and evaluation

Implementation and the financial planning required to achieve a sustainable health and social care system will be a continuous and iterative process that will extend past April 2016.

We will adopt a culture of innovation and learning with our service providers and partners, adjusting our plans as we see what is working. To facilitate this, and in line with planning at the Greater Manchester level, we will adopt an implementation framework that has three-, six-, nine- and 12-month milestones for each programme.

Our approach to implementation will also recognise that we are working within a system of commissioner, service provider and service user interaction and we will seek to use this to achieve greater impact.

  1. Leadership and governance

To achieve transformation will require a shift from organisational management to ‘system’ leadership, with greater collaboration, trust and the sharing of risk across organisations. Our workforce will need to adapt to delivering new models of care across boundaries and in new settings. Our use of IT and our estates will be transformed to facilitate new approaches. This enabling work is taking place at both the borough and the GM level.

The Health & Wellbeing Board will remain a statutory committee of the local authority, and will continue to act as a strategic oversight board with responsibility for monitoring the work and activity that is taking place within the Locality Plan’s fourtransformational programmes.

Our resilience and early help transformational programme will be coordinated and overseen through a collaboration between the Health & Wellbeing Board and the Co-operatives & Neighbourhoods cluster.

Our Early Years transformational programme will be coordinated and overseen by the Best Start in Life Partnership.

The Mental Health transformational programme will be overseen by the Mental Health Strategic Group, made up of officers from the CCG, local authority and service providers.

The CCG has already established an Accountable Care Management Organisation Board which is responsible for driving the necessary developments to establish the ACMO. The joint commissioning and decision-making process between the Local Authority and CCG will be developed as part of the development of the ACMO.

  1. How we will recognise success

We currently monitor and measure our performance on key health and wellbeing outcomes using the following national and local outcomes frameworks and indicator sets:

  • Public Health Outcomes Framework;
  • NHS Outcomes Framework;
  • GM-wide health outcomes frameworks;
  • The Oldham Health and Wellbeing Strategy;
  • The Oldham Plan;
  • Oldham CCG Health Inequalities Framework.

We want to assessthe impact of the four transformational programmes against our triple aims ofimproving health and wellbeing, clinical sustainability and financial sustainability. Working through the Health and Wellbeing Board and the CCG, we will identify outcomes that reflect these three aims and that people in Oldham find useful and fit with their priorities. We will also ensure that where relevant our outcomes are aligned with those of the Greater Manchester strategy.

At a high level, the successful delivery of our Locality Plan will mean that by 2020 we have:

  • Transformed the relationship between the population and the health and social care system, so that the public expects services to promote healthy behaviours, independence and self-care and we reduce dependency on high cost or institutionalised services;
  • A primary care-led place-based health and social care system (the ACMO) that maximises the opportunity to pool budgets, integrate commissioning, and provides outcome-focused integrated care closer to home;
  • A health and social care system that is built upon sustainable financial models;
  • A workforce that has the skills and capacity to enable people to receive appropriate and timely help and support to address the root causes of health problems as well as the presenting symptoms;
  • A health and social care system that recognises and supports a wider associated workforce including carers, other public sector areas such as the fire service, and social housing, voluntary and community organisations and volunteers;
  • Increased the quality and public’s experience of health and social care, delivered greater efficiency, and improved population health outcomes;
  • Developed an evidence base about the effectiveness of our resilience-focused programmes and have scaled these up across Oldham and fostered the widespread adoption of community development and asset-based approaches;
  • A systematic approach to developing community-centred approaches (including social prescribing) to health and social care, working closely with Oldham’s voluntary and community sector.

In conclusion…

The devolution of health and social care responsibilities to Greater Manchester has meant that in Oldham we have brought forward, and given new impetus to, plans that we have been developing and implementing for some time. Partnerships that have been in place have moved on to a higher level of functioning. The sense that the partners in Oldham function with a commitment to the place of Oldham is now firmly established and the groundwork for systems based working across Oldham and in the context of Greater Manchester is in place.

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