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Greater ManchesterHealth and Care Board
Date: 14 September 2018
Subject: Greater Manchester Estates Strategy
Report of: Steve Wilson, Executive Lead, Finance & Investment, GMHSC Partnership
SUMMARY OF REPORT:
The aim of this report is to update the Greater Manchester Health and Care Board on thework being undertaken on developing the estates programme within theme 5.
The paper focuses on the following key areas:
The production of an updated GM Estates Strategy
The development of the GM capital Pipeline and capital financing strategy
RECOMMENDATIONS:
The Health and Care Board is asked to note the GM Estates Strategy and progress of theestates programme.
CONTACT OFFICERS:
Steve Wilson, Executive Lead: Finance & Investment, GMHSC [email protected]
Neil Grice, Area Director: Strategic Estates Planning, Community Health [email protected]
Murray Carr, Director of Land and Property, Greater Manchester Combined [email protected]
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1.0 INTRODUCTION AND BACKGROUND
1.1. The GM Strategic Partnership Board Executive received and endorsed an estatesstrategy in April 2017 which set out the key work programmes for GM andconsidered the interdependencies between the estates work and emerging outputsfrom the wider GM Taking Charge strategy.
1.2. In particular the paper considered the crucial link between the development of localand GM wide estates solutions and the transformation of health and care as a resultof the GM transformational themes.
1.3. The Greater Manchester health and social care strategic plan, “Taking Charge”describes how partners across GM will secure the clinical and financialsustainability of health and social care through a programme of transformationalchange between 2016/17 and 2020/21. The strategy outlined the themes throughwhich transformation would be delivered. These themes are shown in the diagrambelow:
1.4. “Enabling Better Care”, details the changes which will be required to support thedelivery of health and care in the future. In addition to work on workforce, digital,research and development, incentives and new organisational structures, thiselement of the strategy sets out the work that will be required to ensure thebuildings from which we deliver care are appropriate for the services we will deliveras well as being of high quality and cost effective.
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2.0 UPDATED GM ESTATES STRATEGY
2.1. The updated GM Estates Strategy approved by the Partnership Executive Board inJune 2018 is attached as appendix 1. The key elements in the strategy arehighlighted below:
2.2. Estates Vision
2.2.1 The vision for Health and Care Estates in Greater Manchester is:
Seek to drive maximum value from the public estate in order to enable thedelivery of our local strategic & national policy objectives.
Drive development of more 'fit for purpose' flexible & cost efficient estate.Long term this should lead to social & economic benefits includingadditional housing delivery; economic & employment growth.
To move beyond the initial focus on health and care towards a broader,place based approach, strengthening links to the GMCA and the OnePublic Estate (OPE) Programme
2.3. Key Drivers of Estates Strategy
2.3.1 The estates work stream is rightly considered an enabler to the delivery of “TakingCharge”. It is therefore critical it responds to the developing needs of a transformedmodel of delivery of health and care across GM and within individual localities.
2.3.2 The development of individual strategies across all GM themes and within clinicalcross cutting areas will all have an impact on the requirements of our physicalinfrastructure across GM. In addition the work within the other enablingprogrammes, in particular the Digital and Workforce work streams will be significantdrivers of the way we use our estate to deliver clinical and wider services.
2.3.3 The strategy sets out how these drivers have influenced our individual GM estatesprogramme highlighting the following key implications:
Reconfiguration of the estate to ensure the strategic plan can be delivered froma property base that is fit for purpose in terms of location, configuration andspecification.
Through the combined effect of a radical upgrade in prevention, scaling upprimary care, integration of health & social care and the standardisation ofclinical support and back office services, there should be a reduced need forhospital capacity due to inappropriate demand.
There will be requirements for multi-purpose community based hubsaccommodating integrated primary care, community health and adult socialcare services and enhanced provision of step down services preventinginappropriate demand for acute beds.
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Provide increased economic and social value through the re-use of surplusland and property for housing and employment opportunities.
Rationalise estate and maximise disposals.
Efficient management and increased utilisation of the public estate to reducetotal property
3.0 KEY ESTATES PROJECTS AND PROGRAMMES
3.1. The GM Strategic Estates Board has developed a range of projects andprogrammes to support delivery of the estates outcomes and they are outlinedbelow.
3.2. Place-based Master Planning of Acute Sites
3.2.1 A GM master planning Framework has been developed which involves undertakingreviews of acute sites to look at how the estate could be better used to support thedelivery of the STP and locality strategies taking into account the wider publicservice context and linking to Locality Asset Review processes.
3.2.2 The key objectives are to identify opportunities for efficient and effective capitaldevelopments if required, improve utilisation of acute sites and identify land fordisposal and housing development.
3.2.3 The master planning programme will ensure robust communications links with theStandardising Acute Hospital Care programme and involve their representatives inthe programme governance to ensure that process and timings are aligned toensure maximum mutual benefits for both work streams.
3.3. Improving Utilisation
3.3.1 Work is ongoing to improve the utilisation of health and social care facilities acrossGM. The initial work has focussed on community based facilities but it is planned toroll this out to acute sites. Over the past couple of years utilisation studies havebeen undertaken at the key community sites across GM to identify a baselineposition. We have established a key objective: “To optimise the utilisation ofmodern, long-term, multi-use Health Centres to a target utilisation better than 80%”.Going forward it will be important to carry out utilisation studies at acute sites tosupport reconfiguration and business development as well as re-visiting communitysites to measure improvements in utilisation.
3.4. NHS Office Rationalisation
3.4.1 A programme of work has commenced to rationalise the NHS owned and leasedoffice estate across GM. This programme involves rationalisation of a number of(non-clinical) office sites owned or leased by NHS Property Services across GreaterManchester to generate savings on running costs. There is an aspirational target of
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30% reduction that would achieve running cost savings in the region of £5m perannum.
3.4.2 In the past two years there have been over £2m savings achieved and a further£3m planned by December 2019.
3.5. Locality Asset Reviews (LAR) Programme
3.5.1 LARs offer an integrated place based approach to understand communityperformance and needs, public service delivery and service transformation. Theytake a holistic view across all public sector organisations and their combined assetbase. This approach will contribute to the delivery of the ambitions and priorities ofthe Greater Manchester Strategy.
3.5.2 The primary purpose of LARs is to appraise all public sector estate within a localityor neighbourhood in order to ensure that it is effective, appropriate and fully utilised,and, working across all service sectors to assemble where appropriate, right- sizedasset solutions to reinforce an integrated place based approach that underpins theambitions for improved health and community outcomes, social and economicregeneration. LAR acts as a vehicle for maximising or unlocking value from thepublic estate. The completed LAR informs the development of subsequent businesscases.
3.6. Surplus Land, Disposal and Development of Housing Units
3.6.1 A GM working group has been established to support the identification of surplusland and disposal opportunities as part of the GM Devolution Deal Memorandum ofUnderstanding with the Department of Health (DH) and GM Partners. The focus ison identifying land and buildings that will become surplus and progressingopportunities to release land for housing or employment opportunities wherepossible. The group works to collate information on housing numbers and capitalreceipts to meet the DH national target.
3.6.2 The objective of this programme is to identify opportunities for disposals or releaseof land for housing or employment opportunities. A surplus land and disposals listhas been created for GM and target housing numbers and capital receiptsestablished. Capital receipts and the associated revenue savings will be invested inimproving service provision across GM.
3.7. GM Mapping - Health and Social care data mapping
3.7.1 The aim of this work programme is to create an online map that captures:
The entire public sector estate in Greater Manchester
Infrastructure across the city region
Public services and where they are delivered from
Future investment opportunities in social and physical infrastructure
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3.7.2 This will help to inform the strategic planning of estates including the delivery of thekey programmes of work including LARs. The GM map takes information from theNHS SHAPE Dashboard, EPIMS, GMSF, and all other GP partner organisations.Layers of data have been created to capture specific estates and service data toinform the divestment and investment strategy.
3.7.3 It will enable us to have up to date, accurate information about our existing andplanned future estate to inform strategic planning across health, and to utilise healthdata to inform strategic planning in other service areas.
3.8. Develop GM wide Mental Health Estates Strategy
3.8.1 GM HSCP in partnership with Pennine Care and Greater Manchester Mental Healthare developing a GM wide Mental Health Estates strategy. The strategy will coverthe short, medium and long term to support investment that will see significantimprovements in care and services for the next 15-20 years. It will be for the wholeof Greater Manchester (covering 2.8m population) embracing all NHS providers andcommissioners of MH services including community provision.
3.8.2 The objectives of the work are to have a clear strategy for the GM Mental HealthEstate and to identify opportunities for improvement. Key drivers include:
An opportunity for the three main providers of Mental Services in GM to worktogether to develop an Estates Strategy linked to the Mental Health ServiceStrategy for GM
Analysis of the estate portfolio - existing in-patient and community estate; dataanalysis; consultation & site visits; information consolidation
3.8.3 The work will review existing services including where, what and length of contract;review service strategies for Adult MH, Older People, CAMHS, Specialist /Forensicservices for each Trust and include consultation on capacity and estate challenges.
3.8.4 The aim of the programme will be to develop organisational estate strategiesaligned with clinical / service strategy brought together to present a GM widepicture.
3.9. Supporting Locality Strategic Estates Groups
3.9.1 Effective Strategic Estates Groups (SEGs) with the appropriate governance,leadership, membership and resources are crucial to driving forward the estatesstrategy in GM. A “Health Check” of each SEG was undertaken during 2017 andthis has helped to identify the changes required to ensure they are fit for purposeand the recommendations arising have been actioned and will be included in theirongoing implementation plans.
3.9.2 The programme of work has included providing support including specialist estatesadvice and guidance to GM SEGs including supporting localities with recruitmentprocesses as well as levering in capital and revenue funding. This also includes
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supporting localities to set up Operational Working Groups to drive the delivery ofestates projects. The work has also involved developing a prioritisation tool toassist localities prioritise community and acute capital estates developments.
4.0 DEVELOPMENT OF THE GM CAPITAL PIPELINE AND GM CAPITALFINANCING STRATEGY
4.1. A robust and comprehensive capital pipeline is essential to the delivery of the GMestates strategy. A number of the transformation programmes across GM will bedependent on capital investment and new development.
4.2. The GM capital pipeline has been reviewed and subjected to an independentassurance process which has led to a more realistic profile of investments withinlocalities. Work has also been undertaken with NHS providers to ensure that thepipeline captures all capital requirements from that sector.
4.3. Alongside work to develop a robust capital pipeline it is essential there is a clearunderstanding of the potential funding source for any future investments. SMHSCPwill need to maximise the opportunity to access appropriate sources of capital.
4.4. GM has a successful track record of bidding for national NHS strategic capitalfunding, receiving approval for £93m of investment in the Major Trauma andHealthier Together programmes out of a total wave 1 national pot of £325m. Wehave submitted a number of bids as part of subsequent waves of national fundingand expect a response in November, however it is clear additional sources offunding will need to be considered if the pipeline is to be realised in full.
5.0 RECOMMENDATIONS
5.1. The Health and Care Board is asked to note the GM estates strategy and progressof the estates programme.
Greater ManchesterEstates Strategy
July 2018
Greater ManchesterStrategic Context
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GM Strategic Plan: 'Taking Charge'
Locality programmes
GMTransformationthemes
Enabling programmes
GM Cross-cutting programmes
Enabling Better Care; IM&T; Workforce; Estates;Commissioning; Incentivising Reform; Medicines Optimisation
Bolton; Salford; Wigan; Stockport; Tameside & Glossop; Trafford; Manchester; Bury; Oldham; Rochdale
Mental Health; Cancer; Transforming Care; Children’s Services; Maternity; Diabetes
* Information Management & Technology
*
Greater Manchester Estates Vision
The Vision for Estates in Greater Manchester
� Drive maximum value from the public estate to enable the delivery of our local
strategic & national policy objectives.
� Drive development of more 'fit for purpose', flexible & cost efficient estate.
Long term this should lead to social & economic benefits including additional
housing delivery, economic & employment growth.
� Now moving beyond the initial focus on Health and Social Care towards a
broader, place-based approach, strengthening links to the GMCA and the One
Public Estate (OPE) programme.
� Estates vision underpinned by a robust Finance Strategy on how GM intends
to fund the pipeline with an initial priority to work with Department of Health &
Social Care on agreeing how to structure Local Authority investment to
minimise impact on Capital Departmental Expenditure Limit (CDEL).
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GM Service Strategy & Estates Implications
KEY STP SERVICE STRATEGY THEMES
GM TRANSFORMATION THEMESa. Radical upgrade in population health
preventionb. Transforming community based care
& supportc. Standardising acute & specialist cared. Standardising clinical support & back
office services
GM CROSS-CUTTING PROGRAMMESa. Mental Healthb. Cancerc. Transforming Cared. Children’s Servicese. Maternityf. Diabetes
STRATEGIC OBJECTIVESa. Transforming the H&SC system to
help more people stay well & take better care of those who are ill
b. Aligning our Health & Social Care system to education, skills, work & housing
c. Creating a financially balanced & sustainable system
d. Making sure our services are clinically safe throughout
IMPLICATIONS FOR FUTURE ESTATE
PRIORITY AREAS TO ADDRESS ARE:
1. COLLABORATION BETWEEN HEALTH
AND OTHER PUBLIC SECTOR BODIES:
Maximise opportunities around transport,
housing etc. via SEG. Enable wider and more
targeted use of existing facilities for the
prevention agenda
2. HAVE A FLEXIBLE, RESPONSIVE ESTATE
WITH SPECIALIST HUBS: Use high quality
estate that is strategically located in order to
maximise local offer
3. NEIGHBOURHOOD PROVISION RIGHT FOR
PATIENTS AND PRACTICAL FOR STAFF
4. IMPLEMENT URGENT/EMERGENCY CARE
MODEL: Enable delivery of appropriate urgent
care strategies within high quality buildings
5. OUT OF HOSPITAL AND PRIMARY CARE:
Strengthening primary care by consolidation
into larger sustainable provision. Identifying
non-inpatient services to be moved from
hospital sites to the most appropriate location
6. INVESTMENT IN MENTAL HEALTH: Support
mental health development around provision of
community services and UC/A&E services
ESTATES STRATEGY DELIVERY
ENABLERS
PLACE-BASED STRATEGIC ESTATES PLANNING� Grow Locality Strategic Estates
Groups (SEGs)� Locality Asset Reviews (LAR) � Masterplanning of Acute Sites� Mental Health Estates Strategy� Health and Social Care Data
Mapping
DIVESTMENT
� Surplus Land, Disposal & Development of Housing Units
� NHS Office Rationalisation /Office Consolidation
� Utilisation & Estates Optimisation
INVESTMENT
� Capital Investment Pipeline and Financing Strategy
� Delivery of Capital Estates Projects
Greater Manchester Estates Delivery
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GM Estates Delivery
PLACE-BASED STRATEGIC ESTATES PLANNING
� Grow Locality Strategic Estates Groups (SEGs)� Locality Asset Reviews (LAR) � Masterplanning of Acute Sites� Mental Health Estates Strategy� Health and Social Care Data Mapping
DIVESTMENT� Surplus Land, Disposal &
Development of Housing Units
� NHS Office Rationalisation /Office Consolidation
� Utilisation & Estates Optimisation
INVESTMENT� Capital Investment
Pipeline and Financing Strategy
� Delivery of Capital Estates Projects
Enablers
Delivery
Outcomes
The aim of this work is to support each of the SEGs to develop and drive the implementation of the estates strategy in their area:
Enablers:1. Grow Strategic Estates Groups (SEGs)
Completed support in 2017/18:
� Bespoke health checks completed for each locality SEG
� Workshops to review capital investment pipeline in each locality
� Bespoke workshops held with localities e.g. governance, hub development, senior stakeholder buy-in
� ToR updated in line with a place-based approach
� SEG toolkit developed with standardised templates Project prioritisation checklist developed
� Operational Working Groups (OWGs) set up in most localities
Future support:
� Continuing support from GM Estates Delivery Unit
� Support with recruitment of estates roles in localities
� Ongoing reviews of investment pipeline and disinvestment plans
� Implement GM Project Governance approach
� Development of GM Capital Gateway Review Process
� Development of a GM Social Value Policy
� Development of an approach to support development of estates capacity and expertise
vision.
Objectives
To support and enable SEGs to develop and deliver locality and GM estates strategies, which contribute to achieving the estates
vision.
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Summary
SEGs are successfully established across all ten localities in GM with good governance and communications including a quarterly SEG Chairs Forum. They are at various stages of development and the GM Estates Delivery Unit has provided support including specialist estates advice and guidance to SEGs as well as supporting localities with recruitment processes and support to lever-in capital and revenue funding.
Revenue funding of £4.875m secured over 3 years – this funding is a combination of ETTF, OPE, CHP and Transformation Fund monies used to grow the Strategic Estates Groups and fund additional resources including staff to progress the estates work streams identified in the strategic estates plans in each Locality.
Objectives
The need to undertake LARs has derived from other holistic strategies and national reviews such as the Five Year Forward
View, Carter Review and Naylor Review. These strategies have identified the changing needs of residents, how services should
be delivered and the means to enhance efficiency savings across localities.
The primary purpose of LARs is to appraise all public sector estate within a locality or neighbourhood in order to ensure that it is
effective, appropriate and fully utilised and, working across all service sectors to assemble where appropriate, right-sized asset
solutions to reinforce an integrated place based approach that underpins the ambitions for improved health and community
outcomes, social and economic regeneration. LARs act as a vehicle for maximising or unlocking value from the public estate.
The completed LAR informs the development of subsequent business cases. Examples of outputs might be identifying
opportunities for surplus land for housing and employment or developing a locality specific strategic outline case.
Outcomes
� Contribute to an integrated place-based approach
� Undertake a health need analysis linked to Greater Manchester Spatial Framework (GMSF) and increased housing projections to 2035
� Encourage service integration via co-location of services
� Deliver services in line with the needs of the local community within and across neighbourhoods
� Increase capacity for primary care services delivered out of an acute setting
� Contribute towards increased utilisation across the estate
� Align with OPE principles (e.g. release land for housing, job creation, annual revenue savings, capital receipts etc.)
Enablers:2. Locality Asset Reviews (LAR) Summary
LARs offer an integrated place based approach to understand community performance and needs, public services delivery and service transformation, taking a holistic view across all public sector organisations and their combined asset base. Revenue funding of £770k from OPE and ETTF has been secured to roll-out the programme. A final report outlining GM Strategic Estates opportunities is to be completed end of 2018 / 2019, to feed into GM estates strategy.
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Summary
Undertake place-based Masterplanning of acute sites to review usage of sites, dovetailing into the Locality Asset Reviews (LARs) in each locality and informing development of the GM Capital Financing Strategy. Revenue funding of £690k has been secured to deliver this programme of work during 2018/19. A final report outlining GM Strategic Estates opportunities is to be completed end of 2018 / 2019 - this will feed into the GM estates strategy.
Objectives
To optimise support for modern health and social care delivery across the wider area, which each acute site serves, and to
identify opportunities for efficient and effective capital developments if required, to improve utilisation and identify land for
disposal.
Enablers:3. Masterplanning of Acute Sites
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OutcomesBolton FT Masterplan has already been completed and North Manchester General Hospital is underway. Masterplanning will be rolled out to all other acute sites in GM during 2018/19: total programme funding of c£690k has been secured from the GM Transformation Fund.
Outcomes will include:
� Developing a phasing and implementation schedule to identify priorities for action
� Conceptualise and shape a three-dimensional site plan
� Determine the mix of uses and their physical relationship
� Engage the local community and act as builder of consensus
� Identify key collaboration opportunities via OPE
� Relate land disposal opportunities to the GM Spatial Framework
Objectives
To have a clear strategy for GM Mental Health Estate and to identify opportunities for improvement. Key drivers include:
� An opportunity for the three main providers of Mental Health Services in GM to work together to develop an Estates Strategy
linked to the Mental Health Service Strategy for GM
� Creation of new Greater Manchester Mental Health NHS Foundation Trust (following Greater Manchester West NHS
Foundation Trust’s acquisition of Manchester Mental Health and Social Care Trust in 2017)
Outcomes
� Analysis of estate portfolio - existing in-patient and community estate
� Review of existing services including where, what and length of contract: review service strategies for each Trust
� Development of organisational estate strategies aligned with clinical/service strategies brought together to present a GM wide picture
� Identification of urgent capital investment projects, i.e. female Psychiatric Intensive Care Units (PICU) beds (@c£5m) and the redevelopment of Park House in-patient unit at NMGH (c£70m)
� Identification of disposal opportunities
� Development of next steps and timescales� Phase 1: In-patient – February to April 2018� Phase 2: Community – May to July 2018� Interim reports – May 2018� Individual Trust Estates Strategies – July to August 2018� Final report – GM wide Strategy outlining GM wide strategic estate opportunities – September 2018
Enablers:4. GM Mental Health Estates Strategy Summary
GMHSC Partnership in partnership with the GM Mental Health providers is developing a GM-wide Mental Health Estates strategy. The strategy will cover the short, medium and long term to support investment that will see significant improvements in care and services for the next 15-20 years. It will cover the whole of GM embracing all NHS providers and commissioners of Mental Health services including community provision. This will be completed by September 2018. The estates strategy is being developed in parallel with the GM mental health service strategy.
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Objectives
To have up-to-date, accurate information about our existing and planned future estate; to inform strategic planning across
health; and to utilise health data to inform strategic planning in other service areas.
Outcomes
� Mapping health, social care and wider public sector estate assets and services
� Identify relevant data schemas across the city region, standardising data collected
� Produce bespoke maps of existing hubs, new developments, investment and divestment proposals (including opportunities for housing development), Trust sites, Six Facet Survey ratings of GP premises and utilisation levels of sites
The data gathered so far brings together existing data sets across GM, rather than on a CCG–by-CCG basis. Two maps are currently open to access by those with a direct link (health and local government estates teams):
1. The ‘Health Assets’ map pulls together all the data from SHAPE, alongside CCG boundaries, neighbourhood clusters (30,000-50,000 population groupings) and proposed new health and social care hub facilities developments from the capital pipeline
2. The ‘Capital Investment Pipeline’ map pulls together data on the capital pipeline (including the entire pipeline, with a subset looking at proposed health and social care hub facilities), along with hospitals, GP practices, neighbourhood clusters, and CCG boundaries
By collecting the data across GM, we can create a number of bespoke maps, showing a variety of these datasets together.
Enablers:5. GM Health and Social Care Mapping Summary
GM is engaged in a unique project to create online mapping tools that attempt to capture: the entire public sector estate in Greater Manchester; infrastructure across the city region; public services and where they are delivered from; and future investment opportunities in social and physical infrastructure. Layers of data have been created to capture specific estates and service data to inform the divestment and investment strategy. Localities can access these maps via an online portal to help with strategic estates planning. Revenue funding of £146k secured over 2 years.
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Data MappingGM Health and Social Care Mapping Example
Objectives
To identify opportunities for disposals or release of land for housing or employment opportunities. The Locality Asset Review
(LAR) and Masterplanning programmes will provide significant additional opportunities as they are completed during 2018/19.
To release Public Sector Land and Property for regeneration, housing and growth via the One Public Estate Programme.
Outcomes
Completed:� Surplus Land and Disposals list created for GM and target Housing numbers and
Capital receipts� GM Surplus Land and Disposals Group established
Ongoing/Future:� Ongoing work to identify opportunities for surplus land and disposals � Review GM Surplus Land and Disposals list and target Housing numbers and Capital receipts� Work to bring together wider local authority and partner data and move towards broader, place-based approach in
line with the principles of One Public Estate. LAR data and Acute Site Masterplans will dovetail into this process� Develop disposal plans including transfer of sites to Homes England
As part of the development of this revised STP estate strategy, there has been careful consideration of land likely to become surplus to requirements that can potentially be taken forward for planning and disposal in the next 5 year period. Land values in GM are significantly constrained compared to those in the South of England.
Delivery: Divestment -1. Surplus Land & Disposals
Summary
A GM working group has been established to support the identification of surplus land and disposal opportunities as part of the GM Devolution Deal MOU with Department of Health and Social Care (DHSC) and GM Partners. The focus is on identifying land & buildings that will become surplus & progressing opportunities to release land for housing or employment opportunities where possible. The group works to collate information on Housing numbers and Capital receipts to meet the DHSC National Target. See slide 54 for further details.
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The review has identified 52 sites that have the potential to release surplus land of 30.46ha that would allow
development of c1,659 housing units and generate capital proceeds of c£37.66m subject to successful
planning consents
The supported housing
target is 17,500 additional
units up to 2023; circa 750
housing units can be
delivered through the
release of surplus land
Objectives
To rationalise non-clinical office space at NHS PS sites to generate savings on running costs.
Starting position:
� c50 property interests across 29 properties
� Total floor area of c42k sqm (would equate to c5k workstations at 8 sqm / ws)
� Total annual running costs of c£15m
� Majority of estate is leasehold with a number of contractual opportunities before 2020
Outcomes
Key highlights are:
� New Century House, Tameside - the CCG has co-located with the LA, saving £660k p/a
� 3 Piccadilly Place - potential to vacate one floor at 2019 lease end date
� Silver Street, Bury - relocated to Townside & Knowsley Place in Bury making significant savings
� Shire Hill, Glossop - back office and services being moved to Glossop PCC. This achieves a saving, improves access to services, and improves utilisation of a LIFT building
� Project underway to relocate Bolton CCG from current St Peters House office accommodation
� Beckwith House & Kingsgate House, Stockport - NPV savings of £900k+ over 5 years
Delivery: Divestment -2. Office Rationalisation / Consolidation
Summary
GM wide programme to rationalise non-clinical office sites owned or leased by NHS Property Services.
There is an aspirational target of a 30% costs reduction that would achieve running cost savings in the region of £5m pa.
£1.785m (net) savings have been achieved in the last 2 years and a further £3m (gross) planned by December 2019.
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Objectives
‘To optimise the utilisation of modern, long-term, multi-use Health Centres to a target utilisation better than 80%’ and to
relocate services from buildings which are no longer fit for purpose so that they can be rationalised or disposed of. This will
make the most effective use of the public estate across GM and minimise running costs. SEG Operational Working Groups
(OWGs) are a crucial means of improving utilisation within localities and are able to present study data when facilitating
service moves and public sector co-location opportunities. A GM Utilisation Group oversees this work.
Outcomes
Completed:
� Over 50 utilisation studies completed at community sites. 17 of these were undertaken in March-April 2018.
� OWGs have used utilisation data to facilitate key projects. There has been work to improve utilisation levels at key sites. For example, the Walkden Gateway Centre in Salford has extended its out of hours provision.
� Secured funding for 3,200 utilisation sensors for use across GM so that reporting can become a continuous activity rather than a snap shot in time.
� Several organisations have developed agile working policies to encourage flexible use of space.
Ongoing/future:
� A paper was endorsed at our Strategic Estates Board in June which proposes that we focus on five key workstreams: focusing on priority sites, stakeholder engagement, providing OWGs with support, monitoring progress and reporting.
� Working with property companies to develop a more flexible approach. This includes working with CHP to roll out Dynamic Capacity Management (flexible leasing/building stakeholder groups) in pilot areas of Wigan and Bury. NHS PS is also leading on Office Rationalisation and an initiative on sessional space.
Delivery: Divestment -3. Improving Utilisation
Summary
Making optimal use of the existing estate is a key enabler of the overall Estates Strategy. The GM estate varies considerably
in terms of quality and suitability for service provision, with a number of good quality buildings under-utilised and others no
longer fit for purpose. The public sector in GM is paying lease charges for facilities whether they are fully utilised or not. The
difference in cost between average utilisation in key buildings of c.50% utilisation (over 50 buildings have been surveyed since
2015) and our target of >80% is c£17m p.a.
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Delivery – Investment 1. Capital Investment Pipeline
LAR, Masterplanning,
Utilisation, Disposals, OPE
Locality Plans
Provider Capital & Finance Plans
Service Strategies & Commissioni
ng
Future Proofed Capital Pipeline:
� Providing assurance, managing capital exposure risk and supports VFM funding framework
� Scope includes estates, medical equipment, IM&T and will cover social care in the future
� Assurance with capital pipeline aligned to influencing factors Backlog Maintenance Medical Equipment
IM&T Strategic Estates & Transformation
Pipeline Aligned to Influencing Factors
Str
ate
gy
Primary & Community Provider
� Revised pipeline
communicating deliverable
schemes aligned to key
drivers
� Mapping future strategic
projects which will add to
investment requirement
� Capital pipeline based on
three components: prioritised
funded capital; unfunded
capital risk; and strategic
capital
� Linking asset registers to
quantify future capital risk
Engage & RefineEngage & Refine
� Revised SEG Governance
and assurance for future
projects
� Inclusion of social care
investment in future iterations
Reali
sati
on
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Delivery – Investment 2. Funding Strategy
� Development of a strategic finance framework for existing and future capital investment using four building blocks set out here
� Using detail on assets (funding requirement, scope, ownership) in the pipeline to confirm investment quantum, finance terms and commercial structures with different providers of capital
� Initial focus on existing strategic partners in particular Local Authorities and GM LIFT companies and proposed RHIC procurement model
Str
ate
gy
Stage 1 Strategic Partner
Assessment
Stage 2Quantify
� Quantify known Sources &
Uses of capital funding and
determine potential funding
gap to source from
alternative providers
� Develop funding strategy to
bridge remaining funding gap
Stage 3Engage & Refine
� Develop market engagement
strategy and engage with
new providers and
corporates
� Refine Funding Strategy
Reali
sati
on
Asset & Service Requirements
Strategic Alignment
Accounting Framework
Value for Money
� Agree with DHSC
accounting treatment and
CDEL impact of Local
Authority Investment and
leases
� Understand investment
appetite of partners: Local
Authorities, LIF, RHIC
Wave 1 Strategic Capital Approvals
20
STP Capital Wave 1 – Healthier Together
Expected Benefits
GM was successful in attracting £63m of NHS Capital from Tranche 1 of the STP Capital allocation. This will be used to deliver the Healthier Together programme.
Purpose Overview of Scheme
Healthier Together was designed to
address the following service issues:
� Variations of care across Greater
Manchester reflected in high
mortality rates for particular
conditions.
� Lack of compliance with national
standards that exist in Greater
Manchester for General Surgery,
Emergency Medicine and Acute
Medicine.
� Variation in the number of
emergency general surgical
admissions.
� Variations in length of stay, average
length of stay.
� Variation in the attainment of quality
and safety standards for Emergency
and Acute Medicine, with lower than
national average performance
against the 4 hour A&E waiting time
target.
1. All hospitals in Greater
Manchester will make a series of
improvements to the way that they
deliver Acute Medicine, A&E and
General Surgery in order to deliver
a step change in performance.
2. High risk elective and all
emergency general surgery will be
concentrated onto 4 “hub” sites.
� Reliable care - elimination of
variation, equitable care,
accountability.
� Rapid senior decision making
(General Surgery (GS) &
Emergency Department (ED)) –
right care, right place, right time.
� Tangible outcomes which are
visible to the service e.g. National
Emergency Laparotomy Audit
(NELA) audit outcomes – access to
CC, timely access to theatre,
clinical risk management.
� Recent agreement to use Society
for Acute Medicine Benchmarking
Audit (SAMBA) indicators in clinical
benefits dashboard.
� 300 lives pa (GS) – upper quartile
outcome performance
� Increase in ambulatory care (GS &
ED).
21
STP Capital Wave 1 – Major Trauma
Expected BenefitsPurposePurpose Overview of Scheme
GM was successful in attracting £30m of NHS Capital from Tranche 1 of the STP Capital allocation. This will be used to deliver the Major Trauma project at Salford Royal (SRFT).
The Major Trauma Project was
developed
to address the following service issues:� Review of adult Major Trauma services
in Greater Manchester recommended that a single Principal Receiving Site (PRS) be established and that this Major Trauma Centre (MTC) for GM’s adult population should be based at Salford Royal (SRFT). Once established, this would represent the largest Major Trauma Centre in the UK.
� The current A&E department at SRFT, opened in 2011, is now managing nearly 40% more attendances than it was designed for.
� Salford Royal, in July 2016, became an integrated provider of health and social care services. This closer working of Salford Services and the expansion of high acuity services and consequent increase in patient numbers requires a new and differentiated response for local and GM patient flows.
1. The vision, which aligns to one of the five transformation priorities in GM – Standardising Acute and Specialist Care - is for a single service, delivered in partnership across organisational boundaries, for the adult Major Trauma patients in GM, with outcomes to match the best in the world.
2. Dedicated receiving facilities will enable time critical assessment with diagnostics, co-located with theatres and critical care to ensure optimal care is provided within the first few hours following injury by experienced staff for Major Trauma patients.
� Potential to save additional lives beyond those already saved through the existing major trauma arrangements.
� Reduction to A&E attendances.
� Reduced inter-trust patient transfers.
� Improved outcomes (e.g. less long term care required).
� Avoided capital investment at other centres.
� Improved productivity and recurrent revenue savings.
