GREATER MANCHESTER HEALTH AND SOCIAL CARE PARTNERSHIP STRATEGIC PARTNERSHIP BOARD

Transcription

1 NHS Bury CCG Governing Body Paper 6 appendix 6a 5ci GREATER MANCHESTER HEALTH AND SOCIAL CARE PARTNERSHIP STRATEGIC PARTNERSHIP BOARD Date: 29 April 2016 Subject: The Transformation Fund Report of: Katy Calvin-Thomas PURPOSE OF REPORT: The paper sets out a recommendation from the Strategic Partnership Board Executive on the operation of the Transformation Fund. The recommended approach has been developed through a series of workshops which included representatives from across the system. RECOMMENDATIONS: The Strategic Partnership Board is asked to endorse the following recommendations about the Fund: 1. The focus of the Fund will be based on supporting solutions which deliver clinical and financial sustainability across GM and at locality level and improve the outcomes included in the Strategic Plan. A robust Locality Implementation Plan and Transformation Theme Implementation Plan will be a pre-requisite for access to the Fund. 2. Proposals to the Fund should be led by localities or by the GM Transformation Programme Lead with the support of stakeholders. There will be a clear expectation that all proposals will be checked against the Strategic Plan and crossed referenced into locality and GM theme implementation plans to ensure a consistency of approach and coverage. 3. A robust Transformation Fund Finance Process (TFFP) has been agreed for locality proposals which will test robustness and suitability at both locality and GM level. Before a GM led transformation scheme is invited into the TFFP it should be proven to meet equivalent criteria. The test will include:- a. Endorsed by all elements of the system including commissioners, primary care providers, community providers, secondary care providers

2 and mental health providers in a locality and will need to be signed off by its Health and Wellbeing Board; b. Proven to both close the financial gap, improve outcomes and address the underlying opportunity to reduce activity identified through benchmarking; c. Fully embraces the key enablers to the strategy (workforce, estates, IT, payment and contracting systems); d. Supported by a robust implementation approach; and e. Supported by strong governance and monitoring arrangements (including KPIs and risk mitigations). 4. The stages to the TFFP should be: a. Initial proposal: a short submission made by the applicant setting out how the scheme is defined in the locality plan and meets the Transformation Fund criteria; b. Advisory session: a discussion between the applicant and the devolution team regarding the costs and benefits of the scheme. This will identify areas where the applicant needs to do more work to align the proposal to the objectives of the plan; c. Final proposal: documentation of the aims, objectives, inputs, activities, milestones and outcomes of the proposal; and d. Assessment and confirmation: independent assessment of the proposed scheme and a final decision on funding. 5. A formal service agreement will be required between GM and the parties receiving Transformation Funding. This agreement will set out milestones and expected outcomes from the scheme. 6. Payments will be made from the scheme on a quarterly basis. On-going payment will be subject to the successful delivery of milestones and outcomes set out in the service agreement. This will include all outcomes expected from the investment as well as all the key elements which are necessary to deliver transformational impacts. 7. GM will support an applicant throughout the proposal process, however assessment of the final proposal will be conducted by an independent reviewer. 8. Consideration will be given to whether an Advisory Body should be established to assist the SPBE in the evaluation of proposals. Stakeholders will be consulted on this option and any proposals to establish an Advisory Body and the associated capacity requirements will be brought back to SPBE.

3 9. The day to day management of the Transformation Fund should be done internally. In the short term some functions may need to be undertaken by an external provider until a senior team is fully established. CONTACT OFFICERS: Katy Calvin-Thomas Katy.calvinthomas@nhs.net

4 Transformation Fund Key Decisions in Designing the Fund 1. Introduction The paper sets out a recommendation from the Strategic Partnership Board Executive on the operation of the Transformation Fund. The recommended approach has been developed through a series of workshops which included representatives from across the system. 2. Progress made in developing the detailed design of the Fund We have made a commitment to the system that the Transformation Fund will be fully operational by Q1 2016/17. Since February the GM Devolution Team have been working to identify solutions to the key questions surrounding the design and implementation of the Fund. Extensive consultation with stakeholders has been undertaken in the finalisation of proposals. On the 18 th of February SPBE approved a paper from the devolution management team that made a series of recommendations on the Transformation Fund. These included: The Fund operating principles and the criteria on which the Fund should base an investment decision; The direction of travel on the operating model for the Fund; The engagement and communications approach for the Fund; and The proposed work programme on the Fund. This paper was endorsed by Strategic Partnership Board (SPB) on 26 th February Following this endorsement our work on the detailed design of the Fund has progressed at pace supported by the PwC/CF alliance. Key achievements include: We have undertaken a substantive exercise to scope out all of the questions that need to be answered in order for the Fund to go live; We have prioritised those questions and grouped them into a number of key themes; We have begun to develop a series of papers that explore the best approach to each of these issues; We have also identified which questions require engagement with other aspects of the devolution management team (see Figure 1). We have commenced an assessment of locality plans to determine which localities may be ready to come forward to the transformation fund and which need additional support (see accompanying paper)

5 Figure 1: Transformation Fund key questions Investment Assessment Support to Localities Engagement & Communications Transformation Fund Finance Process (TFFP) Proposal evaluation Supporting localities Overall timings Messages to system Operations Transformation fund key questions Administration & Governance Distribution Calls on the Fund Delivering Funding Contracting, Monitoring and Evaluation Governance Transparency Size and shapes of lots Finalising agreements - NHSE Flow of funds to localities Flow of funds within the fund Contracting Scheme monitoring Scheme turnaround Fund evaluation 3. Key design questions During the course of our work we have identified 9 strategically important questions that underpin the detailed design of the Fund. It is essential to reach SPB level agreement on these strategic questions at an early stage. These questions are: Questions relating to the Transformation Fund Finance Process (TFFP) 1. We have said we want the investment approach to be flexible how flexible is that? 2. Given that the Fund is intended for localities and GM wide programmes who can apply? 3. What is the process of and stages to applying to the Fund? 4. What specific support will applicants need in developing plans and developing investment ready schemes? Questions relating to decisions in 2016/17 5. How can the Fund balance the need to spend 60m in 2016/17 in a robust way with the need to set the system up to perform in the future? Questions relating to the management of the Fund 6. Who should make decisions over what to fund and how much autonomy should decision makers have?

6 7. What functions of the Fund should be delivered internally and which should be delivered by independents? Questions relating to contracting between the Fund and applicants 8. What form of agreement should the Fund make with localities? 9. How should funding to successful organisations be structured? To reach resolution on these issues the coordination group (supported by a small number of representatives from the system) held an all day workshop. The outputs of that workshop were discussed and refined on 10 th March The recommended approach is outlined below. Agreement on this approach will allow work to proceed and will put the Fund in a strong place to be open for business in Q1 2016/ Transformation Fund Finance Process Q1. Flexibility of Investment Approach We have said thus far that we want the Fund to be flexible and responsive to the needs of localities. While there are benefits to flexibility (including the ability to shift funds to the most developed schemes, and as an incentive for innovation) there are also risks (including a lack of a blue print for localities, and the risk of white elephant schemes). Thus the question has to be asked how flexible do we want the approach to the Fund to be? We have identified that there are a spectrum of options ranging from a fully flexible fund distribution to fixed amounts for localities and initiatives. These are presented in Figure 2 below. Figure 2: Options for flexibility of the Fund Following discussions it is recommended that the Fund adopt an approach that creates ranges for each initiative based on the strategic plan modelling. These ranges would be communicated to the system as guidance, rather than concrete figures, therefore GM will maintain a degree of flexibility to distribute funds outside of the specified ranges if it sees fit. This approach maintains some flexibly while providing a strong link back to the original basis the funding was secured upon. It also provides guidance to localities over where they should focus their plans. Figure 3 below applies this approach to the strategic financial framework modelling to produce indicative ranges for each of the transformation initiatives. The approach will need to recognise that the cross cutting strategies informing the Strategic Plan overall will need to be considered in the same light. Those

7 significant areas of work (Mental Health, Cancer, Children & Young People) apply across the Transformational Themes and investment needs to be considered and settled in that light. In each case the business case developments either do or will identify investment and impact assumptions which need to be tested with the same rigour as a locality plan or a GM level theme. Similarly delivery may sit across locality plans or be something which GM elects to progress once. Figure 3: Recommended range of funds per transformation initiative included in the Spending Review submission We recognise an inherent question of fairness exists in balancing the objective of using the Fund for transformation, but also for closing the 2 billion gap. Our approach will be to commit to tracking funding recipients and supporting those who have not accessed funds, or those with underlying opportunity to develop investment ready proposals. Q2. Applicants to the Fund One of the most important questions is which parts of the system should lead on different elements of the strategic plan. In coming to this view GM needs to balance the benefits from developing solutions that are tailored to the needs of local populations with the benefits that come from reducing duplication and operating at scale. Having considered the basis on which the Fund was scoped and agreed as part of the CSR, the recommendation is that eligibility should be only to localities and GM initiative leads. Localities will lead on transformation initiatives 1 and 2, while GM bubble leaders will lead proposals for initiatives 3 to 5. This does not mean that these will be the only parties involved in the process for each initiative (see Figure 4).

8 GM transformation leaders for initiatives 1 and 2 will have responsibility to drive cross-initiative coordination and communication to ensure that schemes developed in localities fit well together and that the scope for economics of scale is taken advantage of. Similarly for initiatives 3 to 5 localities GM initiative leaders must cocreate their proposals with relevant localities and individual organisations. To ensure this takes place the recommendation is that applications from these lead organisations are supported by the following groups: Where localities are lead applicants: CCGs, Local Authorities, All providers with more than a 10% share of the CCGs activity, GP federations and H&WBBs. Where GM transformation leaders are applicants: Affected CCGs, Local Authorities, H&WBB and Providers. Figure 4: Proposed role for GM bubble leads and localities for each transformation initiative TF initiative 1. Radical upgrade in prevention 2. Transforming care in localities 3. Standardising acute care 4. Standardisation of support and back office 5. Enabling better care Proposal Lead Localities Localities GM initiative leader GM initiative leader GM initiative leader Role for GM initiative leader in coordinating localities and developing GM wide schemes where there are economies of scale Role for localities in coordinating GM initiative leader and developing GM wide schemes where there are economies of scale Q3. & Q4. Process, Stages and Support Required for the Fund In order to give organisations opportunities to iterate and improve their Transformation Fund proposals, and to ensure that there is sufficient time to provide assurance on value for money, there is a need for a multi-stage proposal process. We have been clear that this will need to apply to both locality led and GM led schemes. For localities the starting point for the Transformation Fund Finance Process (TFFP) is the locality plan.

9 With this in mind the recommendation is that before a locality is invited into the TFFP it should have proven to have a robust locality plan, which is: a. Endorsed by all elements of the system (provider, commissioner, local authority, GPs and H&WBBs); b. Can be proven to both close the financial gap, improve outcomes and address the underlying opportunity; c. Considerate of key enablers to the strategy (workforce, estates, IT, payment and organisation design); d. Supported by a robust implementation approach; and e. Supported by strong governance and monitoring arrangements (including KPIs and risk mitigations). It is also recommended that before a GM led transformation scheme is invited into the TFFP it should be proven to meet equivalent criteria. We have begun to assess the status of locality plans against these criteria (see accompanying paper) Once there is agreement that a robust foundation exists for a programme, the recommended stages to the TFFP should be: 1. Initial proposal: A short submission made by the applicant setting out how the scheme is defined in the locality plan and meets the Transformation Fund criteria; 2. Advisory session: A discussion between the applicant and the devolution team regarding the costs and benefits of the scheme. This will identify areas where the applicant needs to do more work to align the proposal to the objectives of the plan; 3. Final proposal: documentation of the aims, objectives, inputs, activities, milestones and outcomes of the proposal; and 4. Assessment and confirmation: Independent assessment of the proposed scheme and a final decision on funding. The objectives and requirements of each of these stages is summarised in Figure 6. Support will be provided to localities throughout the Transformation Fund proposal process. Two principles will guide this: 1. Support will be provided to reach comprehensive proposal plans 2. The team giving support will remain independent of the evaluation team The expected timetable for this process is provided in Figure 5 below.

10 Figure 5: Expected timetable for wave 1 of the TFFP

11 Figure 6: Transformation Fund Finance Process Robust Locality / Transformation Plan Initial application Advisory Session Full Investment Proposal Independent Review & Decision Objectives To ensure that all localities and transformation initiatives have high quality plans that close the gap, address underling opportunity and improve outcomes for the people of Greater Manchester To provide an initial summary of the proposed scheme and its alignment to the objectives of the Transformation Fund To identify and discuss any inherent gaps to meeting Fund criteria To identify any additional support required for the applicant to secure funding To provide a basis of assessment To add detail to proposals To provide an audit trail Ensure robust allocation of Transformation Funding Highlight any conditions and milestones to be attached to funding Who is involved Applicant supported by GM if required Applicant supported by GM if required Applicant supported by GM if required Applicant supported by GM if required SPB Requirements on applicants A populated activity and finance template and set of programmes approach agreed across provider / commissioner - that demonstrates how they will close gap and address opportunity 100% articulation of segmentation of people and costs Evidence of support from all parts of locality, 2 page summary of the fit of the scheme with the T-Fund criteria Detailed information from the five year locality plan and activity templates Explanation of stakeholder support Clarity over governance arrangements Session will cover: True readiness of the programme Understanding new service models and benefits Opportunities and disadvantages of programme Implications or requirements on enablers (e.g. workforce, IT, etc.) Completion, in entirety of the application Full demonstration how the scheme meets the Fund criteria An activity driven model that sets out the Fund as required and explain how this will reduce future spending and maintain or improve Localities may have conditions to meet before funding is confirmed

12 professionals, patients Evidence of H&WBB sign off by 3 DOFs/ CE of sectors and GPs Robust governance arrangements Evidence of work on key enablers (information, workforce, estates etc.) Evidence of internal locality assurance and monitoring Risk profile: interdependencies on other programmes delivering their locality plan Discuss the investment required annually and anticipated benefits for patients and monetarily Discuss the activity and workforce plan quality Demonstratio n of how a minimum rate of return of 1: 3 will be achieved Detailed, collaborative plan of action that shows how the initiative will be launched and delivered on the ground with resources identified Specify how progress will be evaluated and how learning will be provided to other localities Support from GM GM sponsored support to localities to develop: A clear strategy Aligned local leadership Plans to address the gap and underling opportunity Robust activity and finance returns GM Devolution Team should provide templates and guidance (ongoing) in addition to feedback on individual proposals and examples of successful submissions GM sponsored support should also be made available to localities in completing these stages, for example from GM Bubble Leads, other localities or external advisors. This will highlight to localities where further work is needed, and help them in overcoming these problems Inputs may include: A team, independent from the locality support function, would review each proposal and make a recommendation to the SPB This team could be internal or external

13 Understanding of key enablers e.g estates and workforce projects Effective governance structures, and engaging with the public and professionals Detailed implementation plan Benchmarking tool Locality prescription areas that data show areas for impact 5 year activity & finance plan NHSE requirements Fund process Support may be needed on: Inclusion of content and on Transformation themes 3,4,5 which need to be factored into the sustainability position Any developments to the locality plan to meet the standard for the Fund Calculation of RoI in a consistent manner across proposals This support can be internal or external, but must be independent of the evaluation team to GM The SPB would then either confirm or overturn the recommendation of the independent evaluation team

14 5. Developing a solution to 2016/17 Q5. Developing a robust approach to 2016/17 The allocated funding for 2016/17 is 60m. This includes funding to localities, enablers and any funding GM may wish to give to any pre-existing programmes such as Vanguards, Tameside or Primary Care improvement schemes. Given the potential delivery risk to existing schemes it will be important to reach early agreement on the extent of 16/17 funding to these programmes. To ensure that this funding is not lost and that monies invested deliver benefits for patients and taxpayers a robust proposal process for pre-existing schemes and a few critical enablers must be developed. It is recommended that that Vanguards and other pre-existing schemes are invited into a wave 0 TFFP to ensure that funding awards can be made by the end of Q1 2016/17. This process will ensure that: schemes align to locality plans and GM strategy; asks are reasonable and address the underlying opportunity; there are opportunities to reduce costs through synergies; and robust plans are in place for implementation. The process for this investment process is outlined below in Figure 7.

15 Figure 7: Proposed process for Vanguards and other pre-existing schemes Since initial reviews of the current Vanguard value propositions were conducted in January, wave 0 can be accelerated so that awards can be made by the end of Q1 2016/17.

16 Figure 8: Agreed timings for vanguards and other existing programmes 6. Management of the Fund Q6. Governance of the Fund It is imperative that we communicate who and how funding decisions will be made. It is also just as important to have a strong oversight of the Fund with a clearly defined structure of what the governing body is set to achieve. We have previously resolved that SPB must have ultimate responsibility for oversight of the TF and setting its criteria, and that SPB Executive will be responsible for the Fund s execution. Consideration will be given to the creation of an Advisory Panel to assist in the evaluation of schemes. A further report will be brought to the SPB Executive on this option. Figure 9: Proposed governance structure Strategic Partnership Board and SPB Executive Transformation Fund Advisory body (TFAB) Project approval group (PAG) Proposals Project delivery group (PDG) Monitoring Operations group (OG) Other functions Q7. Role of independent evaluation in operating the Fund.

17 Below the overarching governance structure we have identified a number of core functions and capabilities that will need to be in place within a management team in order for the Fund to operate efficiently and effectively. It is recommended that the Fund should transition to a point where the majority of activities are delivered internally with the exception of evaluation of proposals. However, given the current capacity constraints of the GM devolution team, in the short term, some external support will be needed for the day-to-day management of the Fund until a senior team is fully established. A specific commitment to capacity and capability building by suppliers should be sought to enable GM to transition at pace to internal management of the Fund as shown in Figure 10. Figure 10: The transition of day-to-day activities of managing the Fund from external to internal functions Short term SPB and SPBE Long term SPB and SPBE Key External Internal TFAB TFAB PAG PDG OG PAG PDG OG Evaluation of proposals Contracting, Monitoring & evaluation Performance and reporting Financial management Engagement and communications Evaluation of proposals Contracting, Monitoring & evaluation Performance and reporting Financial management Engagement and communications 7. Contracting between the Fund and Applicants It is important to consider the form of agreement made between the locality and GM and the process of receiving funds. Q8. Form of Agreement We have previously discussed the importance of a binding contract between the localities / transformation programmes and the Transformation Fund. This will set out how the impact of each investment on total mainstream spending will be measured. Future payments will be dependent on the achievement of these impacts. This will ensure that investment does lead to the safe decommissioning required for financial sustainability. There are however a number of forms this agreement could take (see Figure 11 below).

18 Figure 11: Options for form of agreement The recommendation is for the Fund to adopt a service agreement approach. This would bind the system of organisations receiving funds to the delivery of key milestones and outcomes on a periodic basis should they wish to continue to receive future funding. The work to oversee the development of a draft service agreement will be the responsibility of the Governance Sub-Group. At this time we anticipate further work will include: Drafting and finalising the service agreement including specific performance metrics and quality measures that must be met Understanding who should be party to the agreement at the locality and GM: Initiatives 1 & 2 are locality led and should include all parts of the system: provider, commissioner, and local authority Whereas initiatives 3, 4, and 5 require decision making Q9. Structuring funding to successful schemes The recommendation is that receipt of funding will be subject to similar milestones and outcomes achievement metrics as stated in the service agreement and as agreed between the Devolution Team and the locality or GM initiative lead. It is recommended that funding is made on a phased (quarterly), in advance manner. While other options are feasible, it is in the best interest of GM and the locality.