APRIL TO JUNE: Following the successful defence of a Judicial Review in January 2016, sector teams were set up by commissioners and Trusts to complete detailed design work. The TU was appointed by the 12 CCGs in Greater Manchester to provide Oversight and Assurance. The TU developed the Greater Manchester governance required to support the detailed design phase, including, a Greater Manchester Clinical Reference Group and a clinical champion network that would support Trust teams to develop the design in a consistent way. The team set out a Greater Manchester-wide assurance process, with milestones in place to test and challenge the robustness and consistency of the emerging design. During this period the TU also worked with clinical champions to lead the development of a number of pieces of design that needed to be completed at a Greater Manchester level, including pathways for Paediatric General Surgery and Radiology. OCTOBER: Assurance of A&E and Acute Models of Care were completed. JANUARY: General Surgery design and Greater Manchester pathways followed quickly after Christmas. This enabled the TU to advise the CCG Association of Governing Groups (AGG) that the detailed design of Healthier Together remains consistent with the outline Model of Care consulted upon. The TU also provided a financial check and challenge process, delivering a series of financial position statements (stop-checks) to assure the Greater Manchester Health & Social Care Partnership and wider system that the cost of the programme was not materially different to the estimates set out in the Outline Business Case. In January, the Healthier Together commission changed from oversight and assurance of the work led by the sector teams to central programme management. The TU appointed a senior programme director and set out a 90-day programme plan. MARCH: By March the TU delivered a single Greater Manchester Green Book Full Business Case, including estates drawings and a detailed financial appraisal. The TU is managing this document through complex review processes to assess affordability and phasing and agree local, Greater Manchester and national funding. Implementation preparation has also begun, with some sectors now trialling expanded ambulatory care and collaborative multidisciplinary teams (MDTs) and Enhanced Recovery After Surgery+ (ERAS+), a surgical pathway that can significantly reduce length of stay, being rolled out across Greater Manchester. FIGURE 1 HEALTHIER TOGETHER DESIGN ROADMAP • Judicial Review finalised - detailed design work commenced mid January • Greater Manchester governance in place •  Sector governance and programme teams mobilised • General Surgery Models of Care complete - taking the outline model and standards to sufficient detail to implement (e.g. local pathways designed) • A&E and Acute Models of Care complete - we know how each sector will deliver the standards and outline model, including specific: • Workforce plans •  Ambulatory care design • Pathways/transfer policies •  Activity codes that move •  Financial position statement complete - each sector has refined the estimated financial requirement and can describe the actual transition, revenue and capital requirements JULY - OCT 2016 FEB - MARCH 2017 • Greater Manchester design items complete - questions that need Greater Manchester solution are resolved including: •  Paediatric General Surgery •  NWAS pathfinder • Radiology • Performance dashboard •  Outline Business Cases - we now have sufficient detail within each sector to request transition, revenue and capital funding •  Go live preparation complete including: • Staff briefings • Training • Rotas • Tests/trials • Estate/facilities •  Gold Command arrangements and risk management • Benefits tracking • Implementation conditions met APRIL - JUNE 2016 NOV - JAN 2017 19