NHS Cheshire Merseyside Delivering the 5 YFV Narrative

NHS Cheshire & Merseyside – Delivering the 5 YFV Narrative The STP (operating under the name of NHS C+M) will be the 'System Manager' for health services within Cheshire and Merseyside. It will progressively take on responsibility for tasks currently performed by the local NHSE and NHSI offices and, during transition, will be involved in all NHS decisions affecting the area either directly or as co-partner. For example, this would include such issues as winter planning, local performance, service reconfigurations and bids for revenue/capital funding. As System Manager it will hold organisations and partnerships to account for delivery, initially especially in the development and implementation of integrated care, with particular emphasis on cross care working with Councils and the third sector. In addition NHS C+M will lead (and only lead) on matters that are better undertaken at scale. These may include acute sector sustainability, commissioning at scale, workforce planning, system development and clinical networks. The main focus for change and delivery however will be through the development of 'Place-based Care', where all care, direct and indirect, NHS and non NHS, for a defined population will be integrated and managed through a single accountable approach. Initially it is proposed that these Placed-based communities be aligned to each Borough/Council boundary, recognising that there may be sound arguments for some adjustments now and in the future. NHS C+M will support Places to deliver at a pace but it will be for each locality to determine the precise nature of its integration and its relationships as long as primary care and local authorities are seen to be central to, and full participants in, the approach. Equally, local arrangements which ensure robust engagement with all stakeholders at every stage are a core expectation. The current C+M LDSs have served a very useful purpose over the past 18 months but it is proposed that from here on in NHS C+M will work with each of the defined Places to deliver the C+M plan and national requirements. Places and individual organisations may well wish of course to come together to address specific issues of common interest on a wider footprint. Commissioning in its current form will continue to follow the approach led by the DCO C+M in operating as Committees in Common to make best use of resources and expertise. During the coming months commissioning will adapt to the development of Places and the need on occasion to commission at scale. NHS Cheshire and Merseyside will be accountable to the Regional Directors of NHSE and NHSI. Individual organisations will continue to carry their current statutory responsibilities but increasingly bodies will be expected to ensure that actions work for the greater good of the system, and C+M governance arrangements will be designed to manage this healthy tension. Commissioning Committees in Common, the C+M providers Group and the local DCO/DID will be key influencers.

NHS Cheshire & Merseyside – Delivering the 5 YFV Rationale • Context • The rationale for the NHS C&M 5 YFV is to accelerate the implementation of the 5 YFV for the NHS issued in October 2014 amplified and qualified in the NHS FYFV Next Steps of March 2017 • The Cheshire and Merseyside (C&M) Five Year Forward View (5 YFV) framework 5 YFV comprises: 9 local authorities, 12 clinical commissioning groups and 19 NHS providers • It is the 2 nd largest 5 YFV countrywide and building the NHS C&M 5 YFV framework and governance has been time consuming • Time has also been needed to understand the full scope of the 5 YFV • The NHS C&M Partnership includes the entire collaboration comprising the CEOs/Chairs of Trusts, Local Government and GP Providers • The NHS C&M Management Board is drawn from the Partnership to drive the full scope of the work streams forward at tempo • Scope • • • The scope of the C&M 5 YFV must close the 3 gaps – Health & Wellbeing, Quality of Care, Financial Sustainability – by 2020/21 C&M 5 YFV scope includes ‘Place-based Care’ systems, 5 strategic aims, 7 operational performance and 4 enabling streams In order to accelerate the design phase and underpin closure of the gaps the 5 YFV will be assuring benefits-led programmes It will be the work of programme teams, assisted by the programme support/PMO, to manage interdependencies As well as the delivery (gap closing) programmes, financial reporting and comms/engagement are critical functions • Delivery The Management Board approves the programmes that will close the residual gap Initiation of a programme includes the approval of a high quality Programme Initiation Document with precise benefits defined The design process will require sufficient capability (capacity x skills) to deliver options/solutions/plans by agreed dates Decisions on final designs/options may be facilitated and assisted by NHS C&M but authority for implementation remains with statutory bodies as described here in annexes A and B • Where a design(s) requires public consultation the Programme Board will liaise with the appropriate Committee in Common • • • System Management • NHS C&M will act as System Manager • 5 YFVs are about ensuring that organisations are collaborating to effectively manage the NHS C&M system as required under integration and cooperation expectations in the Health and Social Care Act 2012 (2012 Act) et al • Programmes to be supported by: clarity of the measures of success; attainability of those goals; and the robustness of plans • A high level C&M 5 YFV Plan should show the dates, defined by the programmes, at which each programmes enters each phase • Governance • The proposal for governance keeps the process as simple as possible, focussed upon promoting pace/coherence/timely decisions • Commissioning ‘Committees in Common’, the ‘Provider Group’ and the local DCO/DID will be key influencers • The following slides set out the elements of governance in terms of the primacy of delivery and relationships

17/18 Scope NHS (for) Cheshire & Merseyside – Delivering the 5 YFV Placed Based Care Strategic Programmes At Scale Delivery Implementation Director 1. Whole System Integration STP Lead Urgent Care (A&E Delivery Boards, Resilience Place Based Care 2. Acute Sustainability Cancer 5 YFV Systems Out of Hospital Models of Care Primary Care Development and GP 5 YFV Placed-based Care Models Facilitation & Support Documentation & Winter Delivery) Programme Board Cancer Alliance 3. Mental Health & LD Sustainability Right Care & Getting It Right First Time Programme Board Neuroscience Programme Board 4. Carter at Scale CVD Programme Board Diabetes Network Programme Board 5. Prevention at Scale Palliative/End of Life Care Programme Board Enabling Workforce Digital Revolution Estates & Infrastructure Communications & Public and Partner Engagement Financial Sustainability

Structure NHS (for) Cheshire & Merseyside – Delivering the 5 YFV Executive Team Implementation Director Strategic Programmes STP Lead/Managing Director Portfolio Director Service Designer At scale delivery Accountable Care Development Enabling Programmes STP Executive Chair Communications Lead Programme Managers Central Administration Team Clinical Lead Finance Lead Estates & Financial Infrastructure Sustainability SRO & Analysis Medical Directors Forum Clinical Advisory Group Linked to: NHSE C&M DCO NHSI C&M D&ID Accountable Care Development Team GP 5 YFV Providers Forum Leads of CCG Committees in Common Accountable to: NHSE/I Regional Directors

NHS (for) Cheshire & Merseyside – Delivering the 5 YFV NHS C&M Partnership The representatives to the System Management Board act as conduits to their respective chief System executive colleagues Management Programme Review Group Board Executive Team The NHS C&M Executive Team will meet every two weeks. Members comprise the ‘top team’. Remit: - Leadership - Sponsor of whole system integration - Delivery and PMO assurance function - Communication & Engagement The System Management Board will meet monthly. Members comprise 3 x commissioners, 3 x providers (incl. 1 x GP provider), 3 x LA with Exec Team. Remit: - Direct use of resources - Set up and monitor programmes - Manage interdependencies - Generate recommendations - SROs report in rotation The Programme Review Group will meet every 3 mths. Members comprise all SROs , Placed Based Care Leads with Exec Team. Remit: - Ensure delivery to plan - Resolve boundary & interdependency challenges - Unblock other issues - Manage risks - Direct Communications - Receive assurance of benefit The NHS C&M Partnership will meet every 6 mths. Members comprise all NHS Chairs and CE/AOs, Local Govt and GP Providers with Exec Team. Remit: - Endorse changes to scope - Agree and monitor the annual plan - Agree annual allocations - Receive assurance of progress - Decide upon recommendations received Working The NHS C&M portfolio decision making processes will respect the policy and guidance for the reconfiguration of health services provided by the regulatory and departmental frameworks; thus, designs may take one of several possible routes for consideration and consultation. See Annexes A and B. Clinical Advice, Design and Scrutiny Clinical input will be embedded at the level of each clinical programme and verified through the PMO assurance function. The clinical programmes will also be guided and supported by the NHS C&M Clinical Advisory Group.

Duties NHS (for) Cheshire & Merseyside – Delivering the 5 YFV It is the role of each Programme Board to govern each programme from ‘Initiation’ through to ‘Sustain and Review’. This responsibility may be handed down through the 3 levels but assurance must remain at a central point for reporting to the NHS C&M Partnership: Public Sustain & Initiate Design Consultation Implement Review In this context the NHS C&M Partnership, Programme Review Group, System Management Board and Executive Team should focus on the roles described below; these provide the framework for the Terms of Reference for each Group: Executive Team System Mgt Group Programme Review Group NHS C&M Partnership In Scope • Providing leadership and direction for NHS C&M • Day-to day operation of NHS C&M including the HQ and PMO functions • Comms and Engagement planning and delivery In Scope • Prudent use of external and internal budgets • Initiating and assuring programmes • Formulating recommendations for change • Appointing SROs • Action on Updates In Scope • Endorsing the NHS C&M governance regime • Agree Annual Plan • Agreeing annual allocations • Deciding upon recommendations • Referring to Committees in Common Out of Scope • Detailed design work which rests with the programmes • Deciding on governance routes In Scope • Assuring delivery at scale • Resolution of boundary issues and interdependency challenges • Measurement of benefits realised • Manage risks and issues • Ensuring programmes are communicating Out of Scope • Detailed design work which rests with the programmes • Deciding on governance routes Out of Scope • Commissioning changes • Establishing other structures (e. g. LDS) • Committee in Common business

NHS (for) Cheshire & Merseyside – Delivering the 5 YFV Annex A The conceptual view of the phases of each programme together with the route through to decisions – with the potential formal consultation – are shown here. Initiate Design Public Consultation Implement Sustain & Review Consultation required when there is a need… …to notify of substantial developments or variations …where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them…

NHS (for) Cheshire & Merseyside – Delivering the 5 YFV Annex B The extant NHSE process for the management of change proposals is shown here.