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Bolton Locality Plan High Level Implementation Plan Version 1 1 April 2016

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Bolton Locality Plan

High Level Implementation Plan

Version 1

1 April 2016

Contents

Content Page

1. Strategic Context 3 - 8

2. Target outcomes for 2020 9 - 11

3. Key priorities for delivery by April 2016 12 – 14

4. Overview of workstreams and delivery 15 – 16

5. Governance framework, including responsibilities for delivery 17

6. Workstream and detailed activity plan 18 - 30

7. Enablers of change 31 – 34

8. Financial plan 35 – 36

9. Timeline for implementation 37 – 39

10. Communications and engagement schedule 40

2

1. Strategic Context

The Bolton Locality Plan sits within the context of the Greater Manchester Devolution Programme which is aimed at driving the biggest and

fastest improvement to the overall health and wellbeing of the GM population by the end of 2020.

For Bolton, this plan sits within the GM context, but focusses on the elements which will be delivered locally, by all partners working

together to deliver significant transformation change. It makes reference to the elements which will be delivered through the North West

Acute Sector programme (under Healthier Together) and to the work programmes which are being developed and delivered on a GM

footprint.

The Locality Plan sits under the Vision Strategy. The latter being the 20 year strategy for the whole system reform across Bolton, including

the Economic Strategy and Health and Wellbeing Strategy. The enabling workstreams (of IT, Estates, Workforce, Innovation and

Engagement/Communication) underpin all of the strategies, including the NW Sector and GM programmes.

The diagram shown on page 17 illustrates the current Bolton Vision Governance Structure and priorities up to 2016/17 and where the

Locality Plan currently sits. The strategy and governance arrangements are currently under review and will become Bolton’s Vision 2020

and will focus on ‘people and place’ and ‘growth and reform’. The Health and Wellbeing Strategy is also currently under review to ensure it

is aligned to both the refreshed Vision Strategy and the Locality Plan.

The Financial Position

There is an identified gap of £162m across the whole health and care economy in Bolton by 2020. Individual organisation and joint plans for

cost improvement (through efficiency and effectiveness programmes, focus on improving quality and outcomes and vertical and horizontal

integration opportunities) can reduce this recurrent gap by £84m (to £78m). With the requested £20m for the protection of social care this

gap would reduce to £58m. However, the residual gap will require the whole system to reform which will only be possible with transitional

investment particularly in early intervention and prevention services as well as in the estate and IT infrastructure.

Population Health Improvement Programmes

To commission for services to effectively meet the needs of the population of Bolton, we have segmented the locality population (of

300,000) into four “tiers”.

The agreed strategy in the Locality Plan is to pump-prime the new delivery models which will enable the longer term shift in the proportion

of funding from unplanned hospital admissions and long term care placements (reactive care in Tier 1 predominantly) to proactive and

preventative care (Tier 2 for the neighbourhood working, Tier 3 for the medium term and specifically Tier 4 for the longer term)

3

4

1. Strategic context (cont.)

Tier 1 (2%): multiple Long Term Conditions, frail elderly – individual Multi-disciplinary care plans

Tier 2 (10%): developing significant risks associated with Long Term Conditions or frailty - need early intervention and tertiary

prevention to prevent/delay progress of condition and for over 65s: to stay well

Tier 3 (20%): secondary prevention and early identification: targeted interventions for individuals and communities at risk

Tier 4 - System-wide interventions to improve health and wellbeing and prevent future ill-health (primary prevention)

The top tier comprises of 2% of the population (6,000 people) who have two or

more long term conditions, are the high risk frail elderly or those at the end of

their life. There has been significant investment already made into services to

support the individuals within this Tier, including:

Admissions Avoidance

Redesigned Intermediate care services (home and bed based)

Services to support the most vulnerable and complex dependency

The second tier is the population that has started to become ill or frail, but

currently not requiring significant health treatment and/or hospital admission

(and therefore will not necessarily have a risk stratification score) but are

eligible for social care services. These individuals need preventative

interventions to stop them moving into the top tier within the next few years

requiring higher levels of health and social care resources. This is estimated to

be about 10% of the population (30,000 people).

The third tier is population wide early identification and prevention with

targeted interventions for individuals for those at risk of poor health and

wellbeing (20% of the population: 60.000 people). This tier includes a large

proportion of the population who are at risk of long term conditions, for example

due to smoking or being physically inactive, or who may already have long

term conditions, such as hypertension, but don’t yet have social care needs,

and may not be accessing health services beyond primary care. Future

demand on health and social care services could be prevented or delayed

through targeted prevention and early intervention with this population.

Tiers 2 and 3 are where transformation of existing services together with

additional funding is required to commission new and enhanced interventions to

be delivered at individual or on a wider scale. A business case covering all

elements of the transformation programmes is in development. At high level this

includes the following:

Secondary and tertiary prevention, focusing on the specific long term conditions

(and their risk factors) which are most prevalent across the locality: heart

disease, respiratory disease and diabetes - delivered through Integrated

Teams wrapped around general practice (on a neighbourhood basis) –

including Health Improvement Practitioners, ANPs, district nurses, pharmacists,

mental health practitioners and MSK practitioners. This will include signposting

people to the right provision of support, including social prescribing with a

focus on emotional wellbeing and physical activity, to enable individuals to

develop their health skills and knowledge to build their capacity to manage their

own health and wellbeing including stopping smoking, reducing alcohol harm,

eating healthily and becoming physically active. This will include Increasing

dementia diagnosis and improving care, preventing falls, providing GP

care to the frail elderly and ensuring people aged over 65 retain their

independence for as long as possible through physical and mental activity and

reducing social isolation through participation in activities/groups within the

community (to be delivered though expansion of the Staying Well programme

based around GP Practices and full roll out of the Safe, Warm and Dry

initiative).

Population Health Improvement Programmes (cont.)

Putting in place new service delivery models (with investment £23.75m over 5 years) aimed at reducing demand on the system for those currently in

Tiers 1 and 2 now will start to pay back within 1 year and has been calculated to deliver savings of £26.545 over 5 years).

1. Strategic Context (cont.)

5

Key programmes of work targeted at the tier 3

population include:

Integrated Team model (also supporting Tier 2 as

set out above), who will also focus on:

Increasing uptake of screening, including cancer

screening programmes, focusing on populations with

low uptake rates

Increasing uptake of vaccinations – specifically flu

and childhood immunisation

Critical to the successful delivery of the new

neighbourhood models of care is community

development, capacity building and engagement.

These are essential to improving the health of the

population and reducing health inequalities. We will

work with communities which face the poorest health

outcomes, using asset based community

development approaches to build resilience and

empower communities to play an active role in

improving their own health and wellbeing. This will

include a focus on social prescribing, building on the

strengths of the voluntary, community and social

enterprise sector in engaging local communities,

including hard to reach groups, and improving health

and wellbeing. Additional investment could

accelerate the development of these social

prescribing and self-care programmes.

1. Strategic Context (cont.)

6

The fourth tier is system-wide primary prevention to promote good health and wellbeing across the population. This includes population-wide

strategies to promote good health and wellbeing and addressing the wider determinants of health. The Early Years New Delivery Model is key

to this and is a key call on the GM Transformation fund for all localities.

To secure a financially sustainable health and social care system, the impact of interventions in the short, medium and long term needs to be

considered. Investment is needed both in interventions which are likely to deliver a return on investment in the timescale covered by the Locality

Plan, as well as those interventions which will take longer to deliver returns on investment but have the potential to secure greater savings and

significant improvements in population health.

Critical to delivery of the locality aims is the fostering and implementation of a genuine “whole system” approach which includes the community

and voluntary sector as a key driver.

1. Strategic Context (cont.)

7

2. Target outcomes for 2020 (cont.)

Our locality plan prioritises a series of outcomes against which we will monitor our progress in improving health and reducing inequalities. We have

set ambitious targets for each of these outcomes which aim to exceed or narrow the gap with the England average or our peer comparators,

improving the overall health and wellbeing of the population and reducing demand on services. NB: Work has been commenced to look at key

outcomes that will be measured across GM. The initial set of locality plan outcomes and targets may need to be revised as the GM work develops.

OutcomeTarget

Quantifiable benefit at year 5Related delivery

programmeYear 1 Year 2 Year 3 Year 4 Year 5

Reduce local life expectancy

gap to the Greater Manchester

average: men

11.3 11.0 10.7 10.4 10.1 28,439 people in Bolton will live

an average 1.2 years longer.

Integrated

Neighbourhood

Health Improvement

Staying Well

Reduce local life expectancy

gap to the Greater Manchester

average: women

10.9 10.3 9.7 9.0 8.4

Bolton to achieve ‘Better than

average’ yellow ranking on

‘Longer Lives’ for heart

disease and stroke when

compared to similar areas

88.0 77.7 67.5 57.2 47.0 An additional 17 residents/year

will live beyond age 75 years.

Integrated

Neighbourhood

Health Improvement

Staying Well

Reduce the inequality gap

between Bolton and England

for premature respiratory

mortality to half by 2020

46.5 42.8 39.2 35.5 31.9 In 2020, 98 more people in

Bolton will live to over 75 who

would not have done

previously.

Reduce suicide rate 9.5 9.4 9.2 9.1 8.9 8 suicides will be avoided each

year

Integrated

Neighbourhood

Health Improvement

Staying Well

Reduce self-harm admissions

in children

531.7 480.0 428.4 376.7 325.0 93 child admissions will be

avoided each year

Early Years New

Delivery Model

8

2. Target outcomes for 2020

OutcomeTarget

Quantifiable benefit at year 5Related delivery

programmeYear 1 Year 2 Year 3 Year 4 Year 5

Increase the percentage of people

expected to have dementia being on

the dementia register

0.73 0.75 0.77 0.78 0.80 2,834 people will be on the

dementia register

Dementia

Staying Well

Improve breastfeeding at 6-8 weeks

to England average

39.9 41.4 42.9 44.3 45.8 210 more mothers will breastfeed

to 6-8 weeks

Early Years New

Delivery Model

Reduce smoking in pregnancy 15.1 13.8 12.6 11.3 10.0 228 fewer mothers will smoke in

pregnancy

Early Years New

Delivery Model

Children achieving a good level of

development: narrow the attainment

gap between children receiving free

school meals and children not in

receipt of FSM at ages 2,3, 4 and

EYFS.

Original outcome target no longer

applicable. New target needs to be

considered.

Early Years New

Delivery Model

Reducing excess weight in school

children

33.6 32.1 30.5 29.0 27.4 234 fewer children will be of excess

weight when they reach Year 6.

Early Years New

Delivery Model

Reduce the number of alcohol-related

admissions (narrow definition) in

Bolton back to the England average

733.0 711.0 689.0 667.0 645.0 There will be 234 fewer alcohol-

related admissions per year.

Integrated

Neighbourhood

Health

Improvement

Reducing injuries due to falls 890 847 803 760 716 No increase in admissions due to

falls per year. Without a

comprehensive falls prevention

strategy we would expect

admissions to increase to

1082/year by 2020 due to

demographic changes alone.

Falls

Staying Well

Improving Flu vaccination uptake

rate

74.1 75.6 77.1 78.5 80.0 2,874 more older people will

receive flu vaccination per season.

Staying Well

9

3. Priorities for delivery by April 2016

There are priority areas which need to be in place by April 2016 (in high level form) to enable the collaborative design and delivery of the

population health outcomes programmes. These include new contractual models, new commissioning models and new models of care and are

set out below.

Workstream Key Area Lead Actions by April 16 Outcomes RAG

status

Key Priorities for Delivery by April 2016 to enable collaborative design and delivery of population health outcomes programmes

New Contractual

Models

New contractual

model between

Bolton CCG and

Bolton FT

AW (with

SW)

Agreement of new outcome based contractual

model for 2016/17

Agreed contract within financial envelope

to allow the focus on service redesign to

reduce acute demand and overall cost of

care to the system - within the agreed

strategic aim of transformation of the

system from reactive to proactive care

which is based around a person and

community centred approach

Green

Overall Financial

Affordability

Whole system

financial

modelling

AW 5 year view of total cost of the system compared

to the expected income to identify year on year

affordability gap and therefore whole system

savings required

Identification of the combined efficiency

savings required to bridge the significant

financial gap to be bridged – leading to

whole system focus on solutions to

deliver this.

Implementation of the Bolton Offer.

Green

New Commissioning

Models

GM wide

commissioning

GM JCB Agree which areas will be commissioned locally

and which will be on a GM wide basis

Commissioning footprint for locality,

sector and GM footprint agreed to allow

for pooling of budgets and integrated

delivery

Amber

(continued on next page) 10

3. Priorities for delivery by April 2016 (cont.)

Workstream Key Area Lead Actions by April 16 Outcomes RAG

status

Key Priorities for Delivery by April 2016 to enable collaborative design and delivery of population health outcomes programmes

New Commissioning

Models

Integrated

Commissioning:

locality

ML (with

AC)

For locally commissioned services, agree

which will be included within an integrated

commissioning function across CCG and

Council with pooled budgets and appropriate

governance arrangements

Fully integrated commissioning across

health and care to ensure most efficient

and effective use of available resources

and commissioning for outcomes to

deliver the Bolton vision

Green

Design and implement local integrated

commissioning function and governanceAmber

Right Care ML Ensure full use of Right Care Commissioning

for Value approach to identify areas for

evidence based improvement whole system

focus (to include decommissioning)

Strategic whole system prioritisation of

service transformation which is clinically

driven and evidence based and is

centred around improvement of

population health outcomes

Green

Population

Segmentation:

macro and meso

ML (with

AC)

Enhancement of population segmentation

understanding across the 4 tiers, with

commissioning based on this

Commissioning appropriate services

and care based on the understood

needs of the population

Amber

Micro

commissioning for

outcomes

ML (with

AC)

Significantly expand use of personal (health)

budgets to maximise use of resources and

ensure person-centred care to empower

individuals

Individuals and carers have control of

their health and care through deciding

on the services which meet their needs

Amber

Co-production and

Social value at the

heart of

commissioning

ML/AC/DK/A

T

Embed within commissioning full commitment

to social value, maximising the impact of

public expenditure and ensuring the best

possible health and care outcomes.

Fully embed parity in decision making and

developing outcomes locally. Develop a co-

production/user voice programme within the

CVS and Healthwatch

Revolutionise the local approach to

service and system transformation

Red

(continued on next page) 11

3. Priorities for delivery by April 2016 (cont.)

Workstream Key Area Lead Actions by April 16 Outcomes RAG

status

Key Priorities for Delivery by April 2016 to enable collaborative design and delivery of population health outcomes programmes

New Models of

Care

Local Care

Organisation (LCO)

model

JLG Define and agree new model of care for locality

(MCP or PACS)

Appropriate provider models of care in

place which are appropriate to Bolton as

a place

Amber

Design and

implement

neighbourhood

teams based on

need

LH (with

RT/MC/ML and

KS)

Engagement of GP practices re new models of

care / neighbourhood working

Commence scoping of workforce requirements

Commence scoping of health needs of the

neighbourhoods (JSNA for populations to allow

for commissioning of appropriate health and

care teams for neighbourhoods based on

these)

Actions 2016/17:

Agreement of defined neighbourhoods

Determine health and care needs of defined

neighbourhoods

Alignment of Integrated Neighbourhood teams

Alignment of wider community and social care

providers including the voluntary and

community sector

Scope service delivery model including

specialist input

Understand and scope health and social care

capitated budgets

Neighbourhoods are appropriately

resourced, centred around general

practice, to meet the needs of the

populations they are looking after.

Reactive and proactive care models to

make a significant impact on improving

health and wellbeing

Reduction in non-elective conditions for

ACS conditions

Information sharing agreements in place

Access to health and social care records

across the economy

Patient experience measures

Appropriate workforce in place,

determined at scoping phase

Amber

12

Where are we now

13

4. Overview of workstreams and delivery

Population growth:

• By 2020 Bolton’s population is expected to reach 289,000, a 3.0%

increase from today.

• Over the next 5-10 years pre-school, older teenager (16-19 years), and

younger adult (20-24 years) populations will reduce, whilst primary,

secondary school ages, and older age groups, increase.

Ageing population:

• The population aged 65+ is expected to grow by almost 20% to around

57,300 people in 2025. This includes substantial growth in the population

aged 80+ which will increase by over 40% to approximately 16,500 in

2025.

Employment:

• After Manchester and Salford, Bolton is expected to experience the

largest employment increase in Greater Manchester.

• Local employment growth is expected to be concentrated in professional

and business services.

Long-term conditions:

• Long-term conditions, especially cardiovascular disease (CVD), are the

chief causes of Bolton’s health inequalities.

• Diabetes and other forms of CVD are very strongly associated with

ethnicity and deprivation e.g. risk of diabetes for people of South Asian

ethnicity is about 6 times higher than for people of white ethnicity.

• Approximately 16,000 people in Bolton today have some form of CVD and

this is likely to increase to over 17,000 people by 2020.

• The total number of people with diabetes is expected to reach 12,160 in

the next four or five years.

• Trends in CVD and diabetes will also be strongly influenced by rising

rates of obesity.

Social care needs:

• An estimated 20,500 older people in Bolton have some social care

need. This could grow to 27,100 people by 2030.

• Assuming continuation of current patterns of care:

• Local authority-commissioned home care hours would need to increase

from 20,800/week to 27,600 by 2030

• day care placements would need to increase from 410 to 540

• supported residential placements from 840 to 1,100

• 150 additional care home places will be required by 2020 and a further

260 places by 2025.

Dementia:

• Number of people aged 65+ with dementia is expected to grow by 35.9%

to 4,203 in 2025.

• ¼ of hospital beds are occupied by patients with dementia and these

patients stay in hospital longer than others with the same condition.

Falls:

• 30% of people aged 65+ living at home and 50% of people aged 80+

living at home or in residential care will experience a fall at least once in a

year.

• This equates to approximately 20,000 falls/year in Bolton now

and 25,000/year by 2025.

Social isolation:

• There are estimated to be between 3,670 (6%) and 4,705 (13%) people

over 60 years who often or always feel lonely in Bolton today. These

numbers are likely to increase with growth of older population.

Our vision is to significantly improve health and wellbeing outcomes for the whole population of Bolton. Within this our key aims are to improve life expectancy and experience for all people living in Bolton and reduce inequalities in life expectancy within the locality.

To achieve this we are focussing on the key areas of transformational change noted in the Greater Manchester Plan, Taking charge of our Health and Social Care. These are:

a) Population health/early intervention and prevention

b) Transforming community based care and support

c) Standardised acute and specialist care

d) Standardised clinical support and back office

On this page we have set out a high level overview of how we will achieve our vision in relation to the two areas of transformational change that are able to be influenced at the local level: population health/early intervention and prevention and transforming community based care and support.

14

4. Overview of workstreams and delivery (cont.)

Early Years: New Delivery Model

Reduce levels of liver disease

Early identification: find the missing 1000s

Increased physical activity

Social prescribing, self care

Reduced social isolation and retention of

independence

Early intervention: secondary and tertiary

prevention to prevent/delay progress of one or

more long term conditions

CASE FOR CHANGE PRIORITY POPULATION GROUPS STRATEGIC

INITIATIVES

A Healthy and Vibrant Bolton Locality

a) Population health/early intervention and

prevention

b) Transforming community based care and

support

Improved assessment and care planning -

frailty

Improved Home Care

Significant improvement in falls prevention

care

Improvement in dementia diagnosis and care

Reactive care delivery: Reduction in

unplanned hospital admissions and long term

residential care placements

Last Year of Life Care

Improved and Sustainable Care Home SectorT

he tra

nsfo

rmation w

ork

ste

am

s

Emotional Wellbeing

15

5. Governance framework

Priority

themes:

Partnerships:

Prosperous

Economic

Partnership

Health &

Wellbeing

Health &

Wellbeing

Board

Children &

Young

People

Children’s

Trust

Clean &

Green

Cleaner &

Greener

Partnership

Safe

Be Safe

Strong

Stronger

Partnership

Bolton Vision Strategy 2016/17

Bolton’s current Community Strategy that focuses

on the priorities of:

Achieve economic prosperity and maximise

local benefit

Narrow the gap in outcomes between the

least and most well off

Vision Steering Group

Has overall responsibility for the strategy;

provides strong leadership and challenge

Public Sector Leadership Group

Has specific leadership around key challenges

across Bolton’s public services overall

Health &

Wellbeing

Strategy

Locality

Plan

Economic

Strategy

Complex Dependency

(including Family First and Working Well)

Bolton

Community

Homes Board

Based on the agreed vision for significant improvements across Bolton, the workstreams required to ensure delivery of these have been identified

and set out below. The transformation workstreams have been broken down to align with the key areas of transformational change set out in the

Greater Manchester strategy for reform:

a) Population health/early intervention and prevention

b) Place-based integration

c) Standardised acute and specialist care

d) Standardised clinical support and back office

16

6. Workstream and detailed activity plan

Transformation

Workstreams

Key Areas Lead Actions and Outcomes Year 1

(2016/17)

Actions and Outcomes Year 2

(2017/18)

Actions and Outcomes Years 3-5

(2018/19 to 2020/21)

a. Population

health/early

intervention and

prevention

Early Years

New Delivery

Model

NL GM bid to transformation fund for GM-

wide implementation of EYNDM

Learning from the Early Adopter area to

inform full implementation of the

EYNDM in Bolton from 2016/17

Include the development of a local

service model for parent and infant

mental health aligned with GM

developments of peri-natal MH

Scope plans for a re-designed

integrated service for 0-19 year olds.

Re-profiling of current investment and

service re-design to focus on

prevention. Identify investment

required for peri-natal mental health

Early Years New Delivery Model

implemented as part of 0-19 integrated

service.

Reduce infant mortality

Increase breastfeeding at 6-8 weeks to

45.8%. This equates to an additional

210 more mothers breastfeeding per

annum.

Reduce smoking in pregnancy to 10%.

This equates to 228 fewer mothers

smoking in pregnancy.

Children achieving a good level of

development: narrow the attainment

gap between children receiving free

school meals and children not in receipt

of FSM at ages 2,3, 4 and EYFS.

Requires investment of £2.15m per

annum. Starts to “pay back” after 10

years with full savings being delivered

at 20 years.

6. Workstream and detailed activity plan (cont.)

Transformation

Workstreams

Key Areas Lead Actions and Outcomes Year 1 (2016/17) Actions and Outcomes Year 2

(2017/18)

Actions and Outcomes Years 3-

5 (2018/19 to 2020/21)

a. Population

health/early

intervention and

prevention

Increased

physical

activity

NL Work with locality partners including the

Leisure Trust and NHS providers to develop

physical activity as a key pathway linked to re-

designed health improvement services.

Develop local plans for family-focused

approaches to increasing physical activity in

response to new national obesity strategy.

Include costs of programme within the new

neighbourhood model (from GM

Transformation Fund)

Begin implementation of local plans. Reduce premature mortality from

heart disease, respiratory disease,

cancer and stroke. Reduce

prevalence of heart disease,

stroke and type 2 diabetes.

Reduce excess weight in school

children to 27.4%. This equates to

234 children per year no longer

being of excess weight in Year 6.

b. Transforming

community based

care and support

Reduce levels

of liver

disease

amenable to

health:-

Alcohol related

harm

Blood borne

viruses

Non - alcoholic

fatty

KS

&

LH

Deliver and evaluate complex lifestyle service.

Implement integrated liver group action plan.

Include support for medium risk drinkers

within re-designed health improvement

service.

Implementation of a revised Primary Care

pathway

Increased referrals into local health

improvement services from GPs and PNs

Development of a specialist liver workforce in

primary care

Develop a Fibroscanner Pathway for Primary

Care – to be used for a range of metabolic

syndromes

Develop a new workforce – Health

Improvement Practitioners (HIPs) to work at a

Neighbourhood level to target specific

interventions (Include costs within the new

neighbourhood model [from GM

Transformation Fund]

Use evaluation results to inform future

plans for complex lifestyle support.

Re-design/ re-tender specialist

services.

2-3 GPs with a special interest in liver

disease

Provision of 2-3 specialist liver

disease clinics within primary care

Implementation of a Fibroscanner

Pathway for Primary Care

Improved health outcomes within

primary care closer to home

Access to a range of specialist

behaviour change services for people

at increasing/high risk/dependent

drinkers

Re-designed service in place

Reduce alcohol related

admissions to 645 per 100,000.

This equates to 234 fewer alcohol

related admissions per year

Equity of access to targeted liver

interventions across all

neighbourhoods

Early identification of alcohol

related liver disease

Whole system approach for

tackling liver disease amenable to

health

17

6. Workstream and detailed activity plan (cont.)

Transformation

Workstreams

Key Areas Lead Actions and Outcomes Year 1

(2016/17)

Actions and Outcomes Year 2

(2017/18)

Actions and Outcomes Years 3-5

(2018/19 to 2020/21)

b. Transforming

community based

care and support

Emotional

Wellbeing

KS Complete mental health and wellbeing

needs assessment, including suicide

audit.

Develop local action plan to improve

mental health and wellbeing.

Include emotional wellbeing as a focus

within plans for social prescribing and

health improvement.

Develop local mental health action

plan that speaks to the GM Mental

Health Strategy

Include costs of programme within the

new neighbourhood model (from GM

Transformation Fund)

Develop business case(s) to support

implementation of local action plan.

Continue to implement local action

plan.

Local plans fully implemented.

Reduce suicide rate to 8.8 per

100,000. This equates to a reduction

of 8 suicides per year.

Reduce self harm admissions among

children and young people to below

190 for ages 10-24. This equates to 93

child emergency admissions avoided

per year.

b. Transforming

community based

care and support

Sustain early

identification

at scale and

find the

missing 1000s

LH Scope work needed to improve uptake

of NHS Health Check and screening

programmes in populations with low

uptake rates and/or increased risk

Development of new

strategies/campaigns to increase

uptake in populations with low uptake

rates and/or increased risk

Ongoing review of NHS

Check/screening programmes to

improve uptake

Reduce premature mortality from heart

disease and stroke. An additional 17

residents/year will live beyond age 75.

Increase % of people expected to have

dementia who are on the dementia

register to 80%, so that there are

2,834 people on the dementia register

in Bolton.

Ongoing review of NHS Health

Check/screening programmes to

improve uptake

18

6. Workstream and detailed activity plan (cont.)

Transformation

Workstreams

Key Areas Lead Actions and Outcomes Year 1

(2016/17)

Actions and Outcomes Year 2

(2017/18)

Actions and Outcomes Years 3-5

(2018/19 to 2020/21)

b. Transforming

community based

care and support

Increase early

intervention at

scale and

secondary

and tertiary

prevention to

prevent/delay

progress of

one or more

long term

conditions

SL/LH/K

S

Redesign health improvement services

to provide health

coaching/interventions for specific

identified cohort of population (people

who are developing significant risks

associated with Long Term Conditions)

as key component of the primary care

Integrated Neighbourhood Teams.

Specific focus on reducing prevalence

of and harm from respiratory disease,

CVD, cancer and type 2 diabetes

Develop business case to redesign

services and deliver secondary and

tertiary prevention at scale.

Maximise use of mental health

expertise in integrated care teams

Workforce modelling to deliver new

primary care model

Development of effective targeted

interventions to communities of

identity: use of VCSE and housing

services

All of the above elements included

included within within the new

neighbourhood model (from GM

Transformation fund)

Evaluation of re-designed service.

Reduction in prevalence and improved

management of LTCs.

Reduce internal life expectancy gap

between most and least deprived

areas to 10.1 years for men and 8.4

years for women. This equates to

28,439 people living on average 1.2

years longer.

Improve flu vaccination update rates to

over 80%. This equates to 2,874 more

people being vaccinated per season.

Reduce premature mortality from heart

disease and stroke. An additional 17

residents/year will live beyond age 75.

Reduce the inequality gap between

Bolton and England for premature

respiratory mortality to half by 2020. In

2020, 98 more people in Bolton will

live to over 75 who would not have

done previously.

19

6. Workstream and detailed activity plan (cont.)

Transformation

Workstreams

Key Areas Lead Actions and Outcomes Year 1 (2016/17) Actions and Outcomes Year 2

(2017/18)

Actions and Outcomes Years 3-5

(2018/19 to 2020/21)

b. Transforming

community based

care and support

Social

prescribing,

self care

People

looking after

themselves

and each

other

SL/L

H/K

S/D

K

Develop local plans for social prescribing.

Consider social marketing needed to

transform the population’s approach to self

care and use of services.

Agree a shared understanding across

sectors of the appropriate model for social

prescribing in Bolton.

Develop a voluntary sector led model that

can be accessed by multidisciplinary teams

from the statutory and voluntary sector.

All of the above elements included included

within within the new neighbourhood model

(from GM Transformation fund)

Align model to Staying Well, Integrated

Neighbourhood Teams and new

neighbourhoods (around GP Practices)

Develop a voluntary sector pilot project for

Bolton on a particular demographic to test

the approach for effectiveness. Embed

within the pilot the principle of self-care.

CVS to build capacity within the sector and

support and facilitate the sector to take a

goal orientated, outcome-based approach.

Invest in capacity work to enable individuals

to recognise and realise their own assets in

improving their health and wellbeing.

Begin implementation of social

prescribing and self care plan.

Support neighbourhoods to take

an asset based approach to

improving self care.

.

Social prescribing and self care plans

fully implemented.

Reduce internal life expectancy gap

between most and least deprived

areas to 10.1 years for men and 8.4

years for women. This equates to

28,439 people living on average 1.2

years longer.

Voluntary and community sector that

can deliver goal orientated, outcome-

based support services

20

6. Workstream and detailed activity plan (cont.)

Transformation

Workstreams

Key Areas Lead Actions and Outcomes Year 1

(2016/17)

Actions and Outcomes Year 2

(2017/18)

Actions and Outcomes Years 3-5

(2018/19 to 2020/21)

c. Standardised

acute and

specialist care

Reduced

social

isolation and

retention of

independence

RT More people remaining in their own

home

Improvement in Care and Repair

Service (Home Improvement Agency)

Increase in Safe Warm and Dry

Initiative

Local action plans to align to the

Ageing Well GM Strategies and

agenda

Investment in Asset based approaches

to reduce social isolation and build

stronger community connections

through the Ambition for Ageing

Programme in Bolton

Develop business case for GM

transformation funding to expand

Staying Well programme

Applying learning from pilot projects in

Ambition for Ageing identified areas

and upscaling areas of effective

delivery

Staying Well implemented city wide.

Increased number of older people

connected in their communities

Reduction in social isolation

Reduction in demand on health and

social care services

Increased number of older people

realising their assets to improve their

own health and wellbeing

Reduce internal life expectancy gap

between most and least deprived

areas to 10.1 years for men and 8.4

years for women. This equates to

28,439 people living on average 1.2

years longer.

c. Standardised

acute and

specialist care

Improved

assessment

and care

planning -

frailty

AC/RT/

LH

Investment in scaling up the innovation

and demand reduction work through a

programme of behaviour change/

workforce reform that alters the

mindset of individual practitioners

(micro-commissioners).

This changes ‘micro-commissioning’

behaviour and if wrapped around

reformed primary care with community

health partners, it will make a

significant contribution to improved

outcomes including reduced spend on

items such as prescribing, acute care

and adult social care

21

6. Workstream and detailed activity plan (cont.)

Transformation

Workstreams

Key Areas Lead Actions and Outcomes Year 1 (2016/17) Actions and Outcomes Year 2 (2017/18) Actions and

Outcomes Years 3-5

(2018/19 to 2020/21)

c. Standardised

acute and

specialist care

Improved and

Sustainable

Care Home

Sector

AC Carry out a comprehensive review of the Care

Home sector in Bolton

Run market engagement events residential &

nursing care. This will cover engagement with

providers and also start discussions with

service users around co-producing service

specifications

From the market engagement events we will

identify forward thinking, innovative and

creative providers to work with on co-producing

service specifications and new funding models

that incentivise improvements in quality, a

reduction in hospital admissions and increases

in preferred place of death.

Implement new funding models and monitor

effectiveness

Carry out Market Shaping to ensure future delivery

of suitable in borough provision

Explore new build opportunities and new capital

funding models

Manage poor provision out of the market

Reduction in number of

out of borough

placements

Sustainable high quality

care home sector

c. Standardised

acute and

specialist care

Improved

Home Care

AC /

ML

Alongside GM we will produce an ethical

service specification for home care. This new

service will be renamed to reflect a reformed

approach involving a blended health and social

care model with an integrated front line worker

We will shape the home care market in ways

that ensure that home care staff are full

members of integrated neighbourhood teams,

along with primary care, social care and

community health

As opportunity presents we will deliver the ethical

service specification for reformed home care

Moving away from time and task support will be

flexible with use of PDA/smart phone technology to

monitor compliance and facilitate time banking.

Care will be proactive with carers encouraged to be

intuitive and do what is required not what is on their

task sheet.

Carers to be upskilled to carry out lower level

medical tasks reducing duplication and allowing

district nurses to focus on higher prority patients

Work with the GM team and CQC to revise the

regulatory

framework to facilitate a blending of health and

social care roles.

Sufficiency and stability

ensured in the market.

22

6. Workstream and detailed activity plan (cont.)

Transformation

Workstreams

Key Areas Lead Actions and Outcomes Year 1 (2016/17) Actions and Outcomes Year 2

(2017/18)

Actions and Outcomes Years 3-5

(2018/19 to 2020/21)

c. Standardised

acute and

specialist care

Significant

improvement

in falls

prevention

care

AC/M

L/KS

Complete falls needs assessment.

Develop falls action plan.

Review and re-design falls pathways.

Develop business case to enhance falls

prevention pathway/ services.

Implement the home safety check service

through the Care and Repair Home

Improvement Agency

Implement local plans to establish

a comprehensive falls prevention

pathway.

Comprehensive falls pathway

implemented.

No increase in admissions due to falls

per year. Without a comprehensive

falls prevention strategy we would

expect admissions to increase to

1082/year by 2020 due to demographic

changes alone.

This requires additional investment of

£500k per annum and starts to pay

back from year 1 (£432k) with savings

of £2.443m per annum being realised

from year 5.

c. Standardised

acute and

specialist care

Improvement

in dementia

diagnosis and

care

AC Re-establish Bolton Dementia Partnership to

oversee delivery of our ambition

Develop business case for improved dementia

support and care.

Pilot Dementia Friendly Communities (DFC)

approach in Horwich.

Establish Dementia Action Alliance.

Participate in GM Dementia United programme

Local work re dementia diagnosis improvement

(within 12 weeks) and actions to improve care

for people with dementia including helping

them to remain at home.

Achievement of waiting times from referral to

diagnosis and ensure comprehensive post

diagnostic support for dementia in place

Develop plans to roll out DFC

borough wide (subject to

successful evaluation).

Improve choice of specialist care

locally (EMI Nursing/ challenging

behaviour) including the

development of specialist housing

provision

Develop expertise within the local

workforce for dementia care

Ongoing improvement in case

finding for dementia registers

Implement 5 Dementia United

Pledges across the whole system

Implement Dementia Keyworker

model

DFC in place borough wide.

GM Dementia Programme established

Increase % of people expected to have

dementia who are on a dementia

register (from 68.5% to 80%. This

equates to 2,834 people being on the

dementia register.

This requires additional investment of

£500k per annum and starts to pay

back from year 2 (£366k) with savings

of £1.11m per annum being realised

from year 5.

23

6. Workstream and detailed activity plan (cont.)

Transformation

Workstreams

Key Areas Lead Actions and Outcomes Year 1 (2016/17) Actions and Outcomes Year 2

(2017/18)

Actions and Outcomes Years 3-5

(2018/19 to 2020/21)

d. Standardised

clinical support and

back office

functions

Reactive care

delivery: Reduce,

Prevent, Delay:

Admission avoidance

health and care

teams and improved

reablement and home

based care for

population most at

risk of unplanned

admission

ML/AC Reduction in unplanned hospital

admissions and long term residential care

placements

Reduction in hospital length of stay

Reduce non elective admissions by x per

year.

Reduce long term residential placements

by x per year

Reduce length of stay by x days

d. Standardised

clinical support and

back office

functions

Last Year of Life Care ML/AC Implement strategy

Housing Housing for Independence Strategy

complete and being implemented

Disability Housing Registered updated

Housing Stock condition survey completed

Housing Needs survey completed

Home Improvement Agency/Safe Warm

and Dry radical upgrade proposal –

underway and due for completion first

quarter 16/17 – for implementation

throughout 16/17

Homelessness – help for single

homeless service implemented –

working being undertaken jointly with

Wigan and Rochdale and in

collaboration with the Complex

Lifestyles Project

VSCE All VSCE assets mapped across Bolton,

Voluntary Sector Strategy - being written

following refresh of Bolton Vision Strategy

– due for completion Q2 16/17

VSCE Provider group co-producing this

VSCE grants changed to outcome focus

and realigned to early intervention and

prevention – all grants awarded

Social Isolation – Public Health and

Adult Social Care engaged with the

Ambition for ageing partnership, ageing

and a VSCE and RSL (registered social

landlord) partnership working in 3 wards

in Bolton.

Learning will be used to inform other

initiatives across the rest of our wards

and adopted by other registered social

landlords via the Bolton Community

Homes board

24

6. Workstream and detailed activity plan (cont.)

System Redesign

In order to deliver the radical change in population outcomes, requiring a significant shift in the way we use of resources (moving from

reactive to proactive care models), we need to redesign the current systems of care- from how services are commissioned and

delivered, to how they interface and react with each other.

Transforming Primary and Community Care in Bolton

Central to the new system for Bolton is the redesign of a primary care system which has integrated working at the heart, around

neighbourhoods of natural communities

Phased Approach to the New Models of Care

25

6. Workstream and detailed activity plan (cont.)

Actions from April 2016 (shadow year) to deliver step 1

• Increase the Bolton Quality Contract payment level to £98 per weighted patient (i.e. paid difference between GMS/PMS/APMS and this level) –

additional payment this year reflects general practice team time required to give longer to frail elderly, complete standard care plan, sign up to

info sharing, work with Integrated neighbourhood teams

• Organise all practices into neighbourhoods to develop modernised workforce, i.e. work together to employ pharmacists, health improvement

practitioners, mental health workers, etc. to support GPs to spend more time with most complex patients and to fix workforce gaps that exist by

thinking traditionally

• Support from current ‘Staying Well’ team, Bolton CVS and HealthWatch Bolton to ensure neighbourhoods work on building community assets as

part of their approach to meeting patient need.

Actions from April 2016 (shadow year) to deliver step 2

• Require practices in these neighbourhoods to direct and lead the integrated neighbourhood teams, and build their direction of district nursing etc.

• Both practices and their INTs will have KPIs relating to the production of Care Plans (this is a second step as the shift of leadership will take time

to embed).

Actions from April 2016 (shadow year) to deliver step 3

• Support neighbourhoods to identify the specific needs of their patients and build outreach support from hospital based specialists in areas such

as Heart Failure, COPD, to reduce hospital admissions

• Contractual arrangements will expect providers to work together to deliver outcomes: no change to current employment of any staff but alignment

of incentives in this shadow year

2017/18 plan

• Opportunity to have agreed a new contractual form for a new model of provision (based on Multi-specialty community provider) that builds on

weighted capitation basis that Bolton Quality contract has commenced, with sharing of system savings

26

6. Workstream and detailed activity plan (cont.)

In hoursDeflect back to primary care/other (including patients requiring referral for routine outpatient appointment

Immediate Referral to Admission Avoidance Team – being expanded to provide 24/7 care

Ambulatory Care Centre10am till 10pmSenior CliniciansAll appropriate surgical and medical conditions adults and children (not initially assessed as requiring inpatient admission)

For patients who require an urgent apt with a Consultant within 24 hours: Rapid Access Clinics (mornings 7 days per week)

Senior Clinician – front of A&E

A&E stream

Minors A&E –see and treat within 4 hours

Primary care stream

Out of HoursIf patients need to be seen within 24 hours –appt in OOH in A&E

Out of HoursIf patients do not need to be seen within 24 hours –refer back to own GP practice

Ambulatory Care Urgent Outpatient Alternative to Inpatient Admission

Majors/Resus

Transforming the Urgent Care System

Bolton health and care economy has developed a strategic plan for the redesign of urgent care – to ensure delivery of responsive, emergency and

urgent care when this is required, with the ethos of primary and community based care being the first point of contact for non life threatening illness

and injury. For patients who do enter the urgent care system, the focus is on ensuring that they get to the right service as rapidly as possible to

enable them to return to their home in a timely fashion, with to maximum amount of independence retained.

To this end, the first element of the system redesign is at the front door of the Emergency Department. Having a senior clinician undertaking a rapid

clinical assessment of all those presenting to A&E will ensure that patients who enter the urgent care system are directed to the most appropriate

place (and person) to deliver that care, including the patient’s own GP for appropriate conditions/presentations.

27

The other key element of the redesign of the urgent care system locally is efficient and effective transfer of patients back to their own home (or

usual place of residence). This involves appropriate usage of Intermediate Tier services – with the focus on “think home first”.

The following indicators will be used by the locality in measurement of the success of the urgent care system and all partners will hold each other to

account for delivery of the new system.

28

6. Workstream and detailed activity plan (cont.)

Outcome Domain Metrics

Local Whole System

Balance Measures

SAFER metrics, including:

o Senior clinician review within 2 hours of initial presentation

o Maximum time from decision to admit in ED to transfer to a bed

o Discharge of 40% of people before midday and 75% before 4pm

Reduced Delayed Transfers of Care

Reductions in time to put in place packages of care to keep people at home (maximum of x hours from decision of appropriate

care package)

Reduced time for assessment completion

Reduced Acute Bed Days

Reduced Non elective length of stay

Reduction in Unplanned Hospital Admissions and Readmissions

Number of care packages delivered per 1,000 population

Increased proportion of people able to remain in their own home

Improved support to carers

Improved access to assistive technology

Improved Supported Living

Reduced number of falls

Improved dementia care

Patient survey results on Primary Care Access

Number of additional primary care appointments filled

Reduction in the number of long term placements to residential care on discharge

Increased percentage of people remaining at home 91 days post discharge

Reduced delayed transfer of care for people out of area

Access to RAID services 24/7

National standards including A&E 4 hours target, ambulance handovers and ambulance response times

Increase in the percentage of 111 dispositions to primary/community based care

There are a number of whole system strategic workstreams which underpin the delivery of the locality plan vision and outcomes. Each of these has

a strategy in development with an underpinning governance structure and action plan. The high level deliverables of each of the workstreams is set

out below.

29

7. Enablers of change

Enabling

Workstreams

Key Areas Lead Actions and Outcomes Year 1

(2016/17)

Actions and Outcomes

Year 2 (2017/18)

Actions and Outcomes

Years 3-5 (2018/19 to

2020/21)

Estates Reconfigure the

Bolton Public Estate

to provide patients

and staff with safe,

quality, health and

care environments in

an appropriate

location ensuring

facilities are fit for

purpose for the

services that are

being delivered.

ST Map current estate and

utilisation

Design future estate

requirements (including asset

disposal) in line with strategic

estate plan

Implement year 1 of the Estates

plan

Implement year 2 of Estates

Plan

Implement years 3-5 of estates

plan

Efficiency savings of £2.4m

realised

IT Locality IT Strategy AU Implement Carecentric phase 1 -

agree data sharing agreement

and basic shared care plan to

allow sharing across key

workers (OOH, DNs, social care,

integrated teams).

Implement end of life plans

within shared care plan.

Implement GP feeds to populate

integrated digital care record and

provide staged access to health

and social care

Carecentric phase 2 -

extend use of mobile apps

to key groups Eg District

Nurses. Implement

additional feeds (adult social

services, community and

acute).

Investigate Patient portals

and apps and develop

strategy for deployment.

Carecentric Phase 3 -

implement patient portal to

facilitate self-help. Implement

further feeds (GMW, NWAS).

Extend access to other key

health and care professionals.

Implement patient mobile apps

7. Enablers of change (cont.)

Enabling

Workstreams

Key Areas Lead Actions and Outcomes Year 1

(2016/17)

Actions and

Outcomes Year 2

(2017/18)

Actions and Outcomes Years

3-5 (2018/19 to 2020/21)

Workforce Workforce

Analysis and

Planning

HC Complete analysis of whole

current workforce including the

VCSE

Complete analysis of future

workforce requirements

Develop strategic workforce plan

to bridge gaps including a

competency framework

Communication

and Engagement

Communications

Strategy and Plan

NO /

AT /

Bolton

CVS

Development of robust

communication and engagement

plan

Communications and

engagement activity will look at

raising awareness of the locality

plan and the challenges facing

our health and care services,

whilst also encouraging people to

get involved and make a

#BoltonTakingCharge pledge.

Implement

communication and

engagement plan.

Roll out

communications across

all channels

Monitor the success of

communication activity and

contimue rto focus on key

internal and extern lines of

communication

North West Sector Partnership

Bolton is working in collaboration with Salford and Wigan (acute Trusts and CCGs predominantly) under the Greater Manchester

Healthier Together Programme to deliver significant changes in terms of health outcomes and clinical and financial sustainability. This

North West Sector Partnership has its own strategy and governance infrastructure, and is interlinked with the Bolton Locality Plan, as

the aims and outcomes detailed within the Locality Plan can only be achieved through collaborative working with other NHS and wider

organisations.

30

7. Enablers of change (cont.)

Services Identified for Potential Priority Review

Transformation

Workstreams

Lead Actions by March 2017 Outcomes

Development of

Shared Single

Services

MW Establishment of Shadow Single Service Board for

Priority Services

Pilot of single service Board underway to roll out to

future models

MW Agreed system of performance management and

governance for shared services

Pilot of single service governance underway to roll out

to future models

MW Appointment of new consultants of a single service basis

for identified priority services and those under the

Healthier Together Programme

All future appointments made on the assumption of the

single service within the sector and recruitment

processes and contracts adapted to be fit for the future

MW Agreed clinical model to meet Healthier Together

Standards

Healthier Together Business case Completed.

List of Services Rationale for inclusion Justification Planned

year for

delivery

GM Led?

Breast Lacks clinical resilience for long term: 12mth interim

solution in place

SRFT has an interim only solution. Need to

develop options for sector specific services

within 6 months to inform GM level strategy.

Need to secure resilience

Year 1

(2016/17)

YES

Dermatology Lack of clinical resilience at WWL. SRFT gaps in

capacity.

National medical workforce shortage

Rapid review of options for improving resilience

at WWL.

Clinical quality and safety.

Year 1

(2016/17)

NO

Full sector review with sector solution within 12

months.

Clinical resilience all sites.

Year 1

(2016/17)

NO

Urology Benign Lack medical workforce resilience x 2 FTs Service lacks resilience at BFT and WWL.

Need to develop options for sector specific

services within 6 months. Clinical Quality and

Safety

Year 1

(2016/17)

NO

Key Enabling Objectives

31

7. Enablers of change (cont.)

List of Services Rationale for inclusion Justification Planned

year for

delivery

GM Led?

Interventional radiology

non-vascular

Inadequate service across the

sector. Unable to meet HT

standards for General Surgery

Non-vascular IR services are suboptimal across GM.

There is a pressing need to make progress with

solutions for NV IR services given the co-dependency

with Emergency and Elective General Surgical services

and delivery of the GM HT Standards of care. Workforce

challenges and securing standards of care.

The work will inform GM level work.

Year 1

(2016/17)

HT

Prog

Paediatric General

Surgery (emergency)

Adult GS service changes

requires review of this service.

There is no service at SRFT

which is the high risk EGS site

for the sector.

SRFT is not and will not be a receiving site for Paediatric

General Surgical emergencies. Wigan and Bolton

provide services 24/7 7/7. Whilst GM level work will be

required. Need to develop options for sector specific

services within 6 months to inform Sector Business Case

and to inform GM level work.

Co-dependent service requiring a solution.

Year 1

(2016/17)

HT Prog

Neuro-rehabilitation Lack of capacity in line with

demand. Patient not able to

access right care, right place.

High care costs of delayed

transfers.

Services across the sector are inadequate to meet the

needs of the population. Funding arrangements are not

workable.

GM level work is underway but delivery will rely on a

sector level review of services and pathways.

Quality of care, Experience of Care and Costs

Year 1

(2016/17)

YES

Cardiology Potential for changes within

GM, which may affect volumes

and accreditation of existing

sector units.

The focus is on specialised cardiology. There is a need

for greater information and engagement with specialised

commissioners to understand what changes are

proposed.

Changes unclear at this time.

Year 2

(2017/18)

YES

32

Services Identified for Potential Priority Review (cont.)

As the system starts to reduce the amount which is being spent on reactive care, more resource will be released back to invest in the schemes

(targeted at the population at Tiers 3 and specifically 4) which will pay back in the medium to longer term (including the Early Years New Delivery

model which starts to pay back within 10 years but delivers significant whole system cost reduction and improvements in whole population

outcomes from year 20).

8. Financial plan

33

Savings projected from transformation plansCCG

000's

LA

000's

FT

£000's

Total

£000's

Sa

vin

gs fro

m T

ran

sfo

rma

tio

n

Pu

mp

Pri

min

g

Reducing demand on hospital due to INT redesign LTC management etc £5,366

Stop increasing demand on hospital due to falls prevention management

Reducing demand on social care due to falls prevention over 5 years £4,588

Reducing demand on hospital due to dementia £1,583

Reducing demand on social care due to dementia £1,443

Reducing demand on hospital care due to Staying well £1,013

Reducing demand on social care due to Staying well £2,834

Reducing demand on hospital services due to health promotion and self care etc £1,013

Emotional wellbeing £3,525 £2,179

FT cost reduction reduced LoS, bed days £3,000

Total Savings from Transformation Pump Priming £12,500 £11,045 £3,000 £26,545

Ad

ditio

na

l

Sa

vin

gs

Redesign of Urgent Care £8,084

Right Care £3,356

Readmissions £43

Additional Local Authority Savings TBC

Additional FT Savings (as per Bolton roll up) £30,000

Total Additional Savings £11,483 £0 £30,000 £41,483

Total Savings £23,983 £11,045 £33,000 £68,028

8. Financial plan (cont.)

34

-83

-16 -22

1 5

-45

-10

-28 -24-11

-33

(90)

(80)

(70)

(60)

(50)

(40)

(30)

(20)

(10)

-

10

CCG 20/21 LA 20/21 Provider 20/21 Net 20/21Position

CCGImprovement

LAImprovement

ProviderImprovement

Net 20/21Position afterImprovement

CCG Positionafter

Improvement

LA Position ProviderPosition AfterImprovement

Whole locality do nothing income/expenditure and impact of plan (£m)

35

9. Timeline for implementation

Year 1

16/17

Year 2

17/18

Year 3

18/19

Early Years New Delivery

Model

GM bid to transformation fund for

GM-wide implementation of

EYNDM

Scope plans for a re-designed

integrated service for 0-19 year

olds.

Early Years New Delivery Model

implemented as part of 0-19

integrated service

Increased physical activity Develop local plans Begin implementation of local plans Reduce premature mortality from

heart disease, respiratory disease,

cancer and stroke.

Reduce levels of liver disease Deliver and evaluate complex

lifestyle service

Re-design/ re-tender specialist

services

Reduce alcohol related admissions

to 645 per 100,000.

Emotional Wellbeing Develop local action plan to

improve mental health and

wellbeing.

Develop business case(s) to

support implementation of local

action plan.

Local plans fully implemented.

Early identification: finding

the missing 1000s

Scope work needed to improve

uptake of NHS Health Check and

screening programmes

Development of new

strategies/campaigns to increase

uptake

Reduce premature mortality from

heart disease and stroke

Early intervention -

secondary and tertiary

prevention to prevent/delay

progress of one or more long

term conditions

Redesign health improvement

services to provide health

coaching/interventions for specific

identified cohort of population

Evaluation of re-designed service Reduce internal life expectancy gap

between most and least deprived

areas

Social prescribing, self care Develop local plans for social

prescribing

Begin implementation of social

prescribing and self care plan

Social prescribing and self care

plans fully implemented

Reduced social isolation and

retention of independence

Local action plans to align to the

Ageing Well GM Strategies and

agenda

Develop business case for GM

transformation funding to expand

Staying Well programme

Staying Well implemented city wide

and reduction in social isolation

Transformation

workstream

36

9. Timeline for implementation (cont.)

Year 1

16/17

Year 2

17/18

Year 3

18/19

Improved assessment and

care planning - frailty

Investment in scaling up innovation

and demand reduction work through

a programme of behaviour change /

workforce reform

Improved and Sustainable

Care Home Sector

Carry out a comprehensive review

of the Care Home sector in Bolton

Implement new funding models and

monitor effectiveness

Reduction in number of out of

borough placements

Improved Home Care Alongside GM we will produce an

ethical service specification for

home care

As opportunity presents we will

deliver the ethical service

specification for reformed home

care

Sufficiency and stability ensured in

the market.

Significant improvement in

falls prevention care

Review and re-design falls

pathways.

Implement local plans to establish a

comprehensive falls prevention

pathway

Comprehensive falls pathway

implemented.

Improvement in dementia

diagnosis and care

Develop business case for

improved dementia support and

care.

Develop plans to roll out DFC

borough wide (subject to successful

evaluation).

DFC in place borough wide and

GM Dementia Programme

established

Reactive care delivery Reduction in unplanned hospital

admissions and long term

residential care placements

Reduce non elective admissions

and long term residential

placements

Last Year of Life Care Implement strategy

Transformation

workstream

9. Timeline for implementation (cont.)

1. Assess current state 2. Outline interventions3. Detailed design and

implementation planning4. Implement and monitor

1

23

4

Gain an understanding of the

overall position in Bolton,

evidenced issues, and scope

for improvement.

We will:

■ Map the ‘current state’ with

clinical and operational

teams.

■ Look at enabling functions

that also need to be

considered as part of the

transformation plan.

■ Factoring in the impact of the

wider GM strategy and other

service improvement plans.

Define the transformation

interventions required in detail

prioritising and agreeing the

solutions that will achieve this.

We will:

■ Scope what is achievable

within the required time and

cost envelope.

■ Define what are the most

effective interventions to

implement in order to achieve

the required transformation.

Develop detailed plans for

implementation including

defined KPIs, milestones and a

robust quality impact

assessment.

We will:

■ Develop a detailed business

plan for each solution.

■ Deliver the required

communications, training and

briefings to staff to ensure

they have the understanding

and skills to implement the

revised ways of working.

Implement the detailed plans

and robustly monitor their

completion, impact and

outcomes.

We will:

■ Support the delivery owners

in implementing

transformation plans.

■ Monitor the completion of

actions and data analysis to

confirm impacts.

Our plans for the implementation of the outlined transformation workstreams broadly follow a four stage approach. The delivery of this will differ

according to the maturity across each workstream, the time taken to deliver may differ according to the complexity of the activities.

The four stage implementation process1. Assess current state

2. Outline interventions

3. Detailed design and implementation planning

4. Implement and monitor

37

The communications and engagement activity outlined in this plan will be led by the CCG. As the Locality Plan itself is shared between the CCG,

council, and FT we will seek to share it with our partner organisations and encourage them to support and participate in activities as far as possible.

Communications and engagement objectives

• Raise awareness of the locality plan and the big challenges facing health and social care in the coming years.

• People have an enhanced understanding of how their own behaviour (for example in relation to their lifestyle or being active in their

communities) directly contributes towards supporting the future of public services. This changes their perception of the relationship the

individual and local services, which in turn influences and changes their behaviour.

• Obtain input from the public

• Feedback on the plan – has anything been missed?

• Pledges for what they will do - #BoltonTakingCharge

Stakeholders/Key Audiences

Bolton’s locality plan is relevant and likely to be of interest to everyone in Bolton – as users of health and care services. There are nine protected

characteristics set down by the Equality Act 2010 which are listed below -

• Age

• Disability

• Gender (male/female)

• Gender re-assignment (transgender issues)

• Pregnancy and maternity

• Race

• Religion or belief – including lack of belief

• Sexual orientation (lesbian, gay, bisexual, heterosexual)

• Marriage and civil partnership

It is vital that as part of any engagement planned, the above protected characteristics are targeted and given the chance to get involved. This may

require additional work with certain groups, as they may struggle to engage or have never been involved with public service engagement of this kind

before.

10. Communications & engagement plan

38

Key messages

10. Communications & engagement plan (cont.)

Doing what we have always done is now no longer an option.

This is the start of an important journey for Bolton – we’re on the way to better health and care services, plus a

healthier population.

You’ll be hearing a lot more about our vision for health and care in Bolton over the coming years.

Challenges

More people are living longer, often with complicated health

problems, so they need more help and support to stay well.

The health of residents in Greater Manchester lags behind the

rest of the country – we want to change this.

Money

We need to find ways to do more with less.

If we don’t make some big changes, Bolton will spend more and

more on health and care in the coming years – that’s money we

can’t afford!

By 2020, there will be a gap of £135m between the cost of

health and care in Bolton and the money we have available to

pay for it.

Over the coming years, we will need to change the way we

provide health and care in Bolton so we can balance the books.

Money is tight so we need to look carefully at what the ‘Bolton

pound’ can, and should, be paying for when it comes to health

and care.

Public money should only be spent on treatments and services

that have the most benefit for Bolton people.

£

Aims

We want everyone in Bolton to live longer and healthier

lives.

Our vision is all about changing health and care so we

spend less on hospital care and more in the community.

Our health and care services need to get involved earlier –

before someone gets so ill they need to be rushed into

hospital.

We plan to focus on people with the greatest need for extra

help and support, to stay healthy and independent. This is

likely to be older people with long term conditions.

We want to offer more support to people who are at risk of

developing health problems, before they become ill. This

means more screening and vaccinations, as well greater

support for those who want to lose weight, stop smoking, or

drink less alcohol.

This isn’t just about physical health – improving the mental

health and wellbeing of Bolton people is a big priority too.

We want to provide greater support and better care for those

with mental health problems. This means getting the right

care when it’s needed - whether that’s urgent support in a

crisis or counselling sessions for anxiety.

39

Key messages (cont.)

10. Communications & engagement plan (cont.)

How

To change things, we’ll need to work differently.

We want health and care services to work in a more joined up way, in Bolton, and right across Greater Manchester.

We’ve got lots of ideas for how things can change so your health and care services are even better. Now we want to know what you

think.

Nothing will change overnight. This is all about gradual service changes to meet the difficult challenges ahead.

Taking Charge

• Bolton Taking Charge is part of a Greater Manchester wide

movement in response to the significant challenges now

facing our health and care services.

• Bolton Taking Charge is all about getting local people

involved in thinking about and planning for the future of health

and care in Bolton.

• We need to make big changes and we can’t do it alone – you

have a big part to play.

• We want to change the way people and communities take

charge of, and responsibility for, their own health and

wellbeing - whether they are well or unwell.

• We want Bolton people to do more to take care of their own

health and wellbeing, which could mean taking steps to stay

healthy, managing a long term condition, or using health and

care services appropriately.

#BoltonTakingCharge pledges

• We can all make a difference - what will you do?

• How could you take charge of your own health?

• What could you do in your local community to

support your health and care services?

• Examples:

– Pop in to see an elderly neighbour for a cup of

tea.

– Set up a walking group in your community.

– Stop smoking.

– Reduce the amount of alcohol you drink.

– Call NHS 111 when your child is unwell, before

heading straight to A&E.

• Make your pledge today on social media, the

online forum, or by writing it on a pledge card.

If pushed….

This is not a consultation and we are not talking about specific service changes. If there are any future changes which may affect how services are

provided there will be formal consultations with the public and affected staff.

40

Communication & Engagement Mechanisms

Communications and engagement activity will look at raising awareness of the locality plan and the challenges facing our health and care services,

whilst also encouraging people to get involved and make a #BoltonTakingCharge pledge.

Putting more responsibility on members of the public to take action to protect their health and care services is a core element of the plan. This will

be highlighted in Bolton by encouraging people to make their own pledges for what they will do. Pledges may relate to lifestyle changes or

community activities. This will provide the CCG with valuable intelligence about the public’s response to the core messages in the plan, as well as

helping to grab people’s attention and get them engaged. Members of the public will be encouraged to send their feedback and

#BoltonTakingCharge pledges using social media, the online forum, the Let’s Make It email address, or a freepost envelope. We will look into the

use of post boxes distributed to GP practices for a previous campaign and whether these could be used for #BoltonTakingCharge.

We will invite members of the public, GPs, CCG staff, and any local key influencers to be photographed with their pledge. The photographs will

then be used for a range of purposes including social media and issued with press releases. Short films will also be made of individuals sharing

their #BoltonTakingCharge pledges, including community group leaders and board members. This could include other languages, such as BSL and

Urdu.

Activity will begin mid-February to time with Greater Manchester led initiatives. There will follow a concentrated push from mid-February to April to

grab attention and engage local people. We will then build on this foundation with continued activity and communications over the coming months.

All of the communications and engagement activity set out in this plan will be rolled out under the Let’s Make It brand. However,

#BoltonTakingCharge will need a recognisable visual ‘identity’ within this brand to help us to build familiarity and recognition with the public.

Digital communications

• New, dedicated page on the new CCG corporate website. With link to the online forum on the Let’s Make It website.

• Will be used as an opportunity to boost use of the Let’s Make It forum. Tactics will include encouraging partner organisations to post and

starting focused topic threads, with promotion via social media.

• Daily messaging using corporate and Let’s Make It social media channels. This will be supported by images to ensure that posts are eye

catching and more likely to be shared.

• Social media will be planned with a thematic focus for different weeks, reflecting the locality plan. The #BoltonTakingCharge call to action

posts will continue throughout.

• Local partners will be asked to support by sharing posts and using a list of pre-prepared social media posts provided by the CCG on their own

channels.

10. Communications & engagement plan (cont.)

41

Digital communications (cont.)

• Members of the public will be encouraged to post their feedback and #BoltonTakingCharge pledges using social media or the online forum.

• New background images linking to the artwork and messages for this work will be used on CCG Facebook and Twitter channels for a pre-

agreed length of time.

• Short filmed interview with Wirin and Paul Horrocks (£) – available online and screened at public meetings, events etc.

Media relations

The launch of the #BoltonTakingCharge initiative will be launched with a press release, which will be posted on the CCG’s corporate website and

the Let’s Make It website, as well as a column in the Bolton News.

The Bolton News and Bolton FM will be asked to support this initiative. We will also seek to utilise our relationship with the Bolton Wanderers

Community Trust, as it may be possible for messages to go on their social media, matchday programmes, website etc. Other channels to consider:

• Xplode (there is a cost for coverage in the magazine)

• Bolton Carers Support newsletter

• Bolton CVS

• Tower FM

• Key 103

• Bolton Live (online channel)

• Manchester Evening News

• Living in BL (free newspaper for West Bolton)

• Horwich Advertiser

Further opportunities for media coverage will be sought, such as:

• Progress report on pledges received so far.

• Key 103 bus visit.

• ‘Don’t miss your chance’ towards the end of the designated period for submitting feedback.

• Link to national awareness days/weeks/months:

• National Salt Awareness Week – week beginning 29 February

• Ovarian/Prostate Cancer Awareness Months – March

• International Women’s Day – 8 March

10. Communications and engagement plan (cont.)

42

Media relations (cont.)

• International Women’s Day – 8 March

• No Smoking Day – 9 March

• Bowel Cancer Awareness Month – April

• World Health Day – 6 April

• European Immunization Week – week beginning 25 April

• Follow up – encourage media to attend board meeting where analysis will be presented.

• Feature – Bolton Deaf Society recording their #BoltonTakingCharge pledge in BSL

Design/print materials (£)

• A3 poster – distributed to usual locations (e.g. GP practices, pharmacies, libraries etc. plus others)

• Postcard with space for people to write their pledge

• Large pledge cards for use in photos and films

• Summary leaflet

• Presentation

• Social media images

Internal communications

GP practices are on the front line of local health services and practice staff are often a patient’s main point of contact with the NHS. It is therefore

important that practices are aware of and engaged with this initiative. The following will be undertaken to achieve this goal:

• Launch article and follow up articles in the Practice Bulletin.

• Presentation at a clinical leads meeting

• Email briefing from Wirin to GPs

Many CCG staff are Bolton residents and key influencers as well informed individuals in their social networks and local communities. The issues

raised in the locality plan will be relevant to the work of everyone in the organisation. The following will be undertaken to communicate with staff:

• Launch article and follow up articles in the Practice Bulletin.

• Presentation at staff briefing, with pledge cards handed out and a post box at the briefing and then placed in a central place in the building.

• Mention in Su’s exec update emails.

• Posters around the building.

10. Communications & engagement plan (cont.)

43

Paid advertising

Paid advertising, such as on buses or on street, is expensive and not proposed for use as part of this project. However, two possibilities have been

identified that would be more targeted and cost effective than other options.

• Life Channel

• Targets members of the public at their GP practice at a time when they are already thinking about their own health as well as local

services.

• They are a ‘captive audience’ waiting to see their GP, with fewer demands on their attention.

• Bolton News online adverts

• Website has high readership – more likely to be younger?

• Online adverts allow people to click straight through to the website where they will find more information and be encouraged to make a

pledge.

Public engagement

1. Use our increasing contact lists and the Let’s Make It Happen people bank to make sure that people are aware and how they could get

involved.

2. Special edition of the LMI newsletter – ‘what does this mean for you?’ to encourage our contacts and panel to get involved, and an invite for

us to visit to give a presentation.

3. A focus group with a presentation - aimed at those hard to reach groups.

4. ETAG - presentation, round table discussions and request further feedback.

5. Attend public events to hand out summary leaflet and collect pledges/feedback. Public events (so far): Health Mela (12th March), CCG

roadshow (date tbc)

6. Roadshow – use the campervan to interview the public and gather footage to include with the final report to Board. Also collect pledges and

encourage people to have their pictures taken holding their pledges.

7. Presentation - includes the GM context and then more detail on the plan for Bolton. In simple but hard hitting language so that the public fully

understand the situation, and understand what their role is. This presentation to be given to all groups visited and placed on the website.

8. Visuals to be sent to Bolton Uni/Bolton College for display on their screens.

9. Theme based focus groups held with the voluntary sector.

A survey will be run at a GM level, along with a roadshow run by Key 103.

10. Communications & engagement plan (cont.)

44

Feedback Process

As the CCG will be gathering a lot of feedback from the public, it is important it is clear what will happen to the feedback, and we have a full process

in place to collate and analyse everything that is received. All hand written views/pledges/feedback posted on our websites/twitter etc. will be

inputted into an excel database and coded according to theme. This database will have a category for how the feedback was received. Admin

support will be needed to input these responses and pledges, and a regular check done every week by the team to see what themes are emerging.

A full report and analysis will be written and presented to the CCG’s Board. The analysis of what is collected will be done by the CCG. This analysis

will be published by using our normal channels such as the CCG and LMI websites. All feedback will also be sent onto the GM Devo team for them

to take into consideration.

Risks / challenges

45

10. Communications & engagement plan (cont.)

What’s ‘up for grabs’?

It is important to be clear that this is not a consultation and does not

relate to specific service changes. We must manage expectations

and be clear as to the process, what we are asking, and what can be

influenced by the public.

‘It’s just like Healthier Together’

This initiative will follow soon after the announcement of the

Healthier Together judicial review. This process has meant that the

controversial consultation has been in the public eye a great deal

over recent months. Some people may view this as being similar to

Healthier Together, impacting on how receptive they will be to our

messages.

Limited resources

The communications and engagement activity set out in this plan

reflects a significant amount of resources in terms of both NHS

funds and staff time. We must be clear at the outset as to what can

be delivered and what budget is available, in order to manage the

expectations of CCG senior managers and board members.

It is also important to prevent ‘cross over’ work being done by the

CCG and those who are also involved from a local or GM level.

GM influence and control

Although this is a locally driven initiative, #BoltonTakingCharge links

into a wider GM led programme of work. This means that our work

in Bolton may be influenced and affected by other events outside of

our control. It is important for the reputation of the CCG and the well

established relationships with have local community groups that we

complete the ‘feedback loop’ and provide an update once all the

feedback and pledges have been submitted. However, we will to an

extent be reliant on GM bodies to feed back to us before we are able

to do this.

Activity Date Location Lead person Resource (£) Progress

Printing and delivery of summary leaflet (x2000) 11/02/16 JP £303 Completed

Press release - launch (issue 08/02/16 – embargo for 15/02/16) 15/02/16 SFH £0

Completed

Dedicated web page on CCG corporate website 15/02/16 SFH £0 On LMI website

Start thread on Let’s Make It forum 15/02/16 SFH £0 Completed

Social media calendar – themed posts 15/02/16 –

29/04/16

SFH - content

JP – design of images

£0

Posts in progress

Article in Practice Bulletin 16/02/16 SFH £0 Completed

Presentation at staff briefing 16/02/16 NO £0 Completed

Wirin’s column - launch 23/02/16 SFH £0 Completed

Article in Staff Focus 25/02/16 SFH £0 Completed

Press release – National Salt Awareness Week (issue 22/02/16 – embargo for

29/02/16)

29/02/16 SFH £0

Not started

Wirin’s column – mental health 01/03/16 SFH £0 Completed

Press release - Key 103 bus (issue 01/03/16) 08/03/16 Vic Sq SFH £0 Not started

Press release – progress report on pledges received so far March SFH £0 Not started

Press release – Prostate/Ovarian Cancer Awareness Months March SFH £0 Not started

Include in Su’s Exec Update to CCG staff March SFH £0 Not started

Press release – International Women’s Day (issue 01/03/16 – embargo

08/03/16)

08/03/16 SFH £0

Not started

Press release – No Smoking Day (issue 02/03/16 – embargo 09/03/16) 09/03/16 SFH £0 Not started

Press release – don’t miss your chance to feed back April SFH £0 Not started

Press release – Bowel Cancer Awareness Month April SFH £0 Not started

Press release – World Health Day (issue 30/03/16 – embargo 06/04/16) 06/04/16 SFH Not started

Press release – European Immunisation Week (issue 18/04/16 – embargo

14/04/16)

25/04/16 –

30/04/16

SFH £0

Not started

Press release – CCG roadshow May SFH Not started

Article in Xplode tbc SFH £700

(dble page)

Look at next financial

year

Press release – analysis to be presented at CCG board tbc SFH £0 Not started

Interview film with Wirin tbc SFH £0 JP supplied filming

contact

Life Channel advertising tbc NO £? Not started

Bolton News online advertising tbc SFH £? Details to be agreed

Pledge cards tbc JP £? Not started

Posters tbc JP £? Not started

Large pledge card for photos/films tbc JP £? Not started

10. Communications & engagement plan (cont.)

Communications and engagement plan delivery schedule

46

Engagement Date Location Lead person Resource (£) Progress

Roadshow February HC £? Asked Key for date they

are visiting Bolton

Stall at Health Mela 12/03/16 HC £0 Booked to attend

Presentation to Youth Council 02.02.16 NO/JP/HC £? HC writing presentation.

Info gathered. JP

developing props

Special edition of newsletter Feb HC £0 Not started

Presentation/pledge session with New Openings (LD) tbc HC £0 Not started

Send electronic posters to Bolton College/Uni for display on their screens tbc HC £0 Waiting for poster to be

designed

Presentation/pledge session with Care4 (LD) tbc HC £0 Check HW are not

already visiting group –

LD carers

Presentation/pledge session with LGBT group tbc HC £0 Asked Bolton LGBT

partnership for help.

They are looking into

when I could visit to

present/gather pledges

Presentation/pledge session with Bolton Blind Society tbc HC £0 Not started

Presentation/pledge session with Bolton Deaf Society? tbc HC £140 interpreter

cost

Check if HW are visiting

them

ETAG session March NO/HC £0 Not started

Targeted email to GP patient forums February HC £0 Not started

Send posters to supermarkets/takeaways February HC £0 Not started

Posters in black bag to all primary school February HC/Sports & Living at

Council

Cost of printing

posters Not started

10. Communications & engagement plan (cont.)

Communications and engagement plan delivery schedule (cont.)

47