Briefly describe the initiative/ project/service; please include your aims and objectives

For many years commissioners and providers have been grappling with support solutions for people deemed to have very complex needs. We have seen some pockets of best practice but in most instances, we have seen reactive commissioning, alack of consistent co-design, and traditional contracting models at best which do not always result in the best outcomes for people. Across GM, we are changing the way we traditionally respond, building on significant and innovative opportunities to reviewand improve the way we deliver support solutions for people considered to have complex needs. As part of the Transforming Care Programme, the complex lives programme has created homes for people in the community.

The project has enabled the discharge of a significant number of people out of long stay institutions into their own homes in GM.This programme is supporting commissioners to increase capacity to support people in the community, close to family and friends and where they want to be. We work with people that localities have struggled to find support solutions for, via an additional pathway when all other local pathways have been explored. The initial proof of concept has been successful with the Learning Disabilities and Autism workstream and initial work has started on Preparing for Adulthood, Complex Mental Health and Complex Dementia workstreams.

GM Provider Framework – Supporting People to Live Well at Home

In April 2025, GM launched the GM Provider Framework – Supporting People to Live Well at Home  programme, with an objective of moving to one GM procurement framework to create a strategic commissioning framework that brought together scope of both existing frameworks and areas where we knew there was unmet need.The new GM framework was a collaborative project with a large working group representing the different health and care commissioners across GM. An in-person workshop was held in October 2024 for commissioners and practitioners, and a provider event was held in November 2024. We received constructive and practical feedback that helped shape the scope, procurement documentation and process and the procurement process was started in December 2024.The evaluation started in January 2025, an evaluation team of 37 representatives from across Greater Manchester evaluated over 600 bids.The scope of this framework includes seven specialist areas:

• Learning Disabilities

• Neurodivergent

• Complex Lives

• Complex Mental Health

• Complex Dementia

• Individualised Commissioning Including Continuing Health Care (CHC)

• Preparing for Adulthood

The framework covers the following types of service: Residential, Nursing, Supported living, Day opportunities, Homecare, Outreach, Respite and Short breaks, Supported Employment and Volunteering. The framework enables providers to develop and maintain effective working relationships with partner organisations. The partner organisations are10 Local Authorities and 4 NHS Trust.The framework is for high-quality providers who can provide person-centred and outcome-focused care and support. Providers must adopt a strength-based approach, supporting people to recognise and achieve their full potential, whilst also working towards increased levels of health and wellbeing. We think this is the first strategic commissioning framework that has been co-designed across health and carecommissioners, with providers, that spans the geography of a Mayor city region and Integrated Care System.

What are the key achievements?

Adult Social Care in Greater Manchester we have a well-established Adult Social Care transformation programme led by the 10 Directors of Adult Social Services (DASS) and supported by a dedicated programme team and other colleagues across the system. The sub-regional DASS group provide a strong dispersed leadership, collaboration and mutual support across the system and beyond into the northwest and nationally. There are a number of key priorities to support local reform and transformation with a strong focus on workforce transformation, market shaping and development including quality improvement and commissioning, supported housing, learning disabilities and mental health alongside support for carers.

As part of this broader programme of reform GM is committed to significantly reshaping care and support for people. There shaping that will take place will ensure that more care and support is provided in the community and closer to home, with a shift away from long-term hospital care. Complex Lives Projects – Progress Made Phase 1 – Homes for 58 people have been created through 17 completed projects. 44 people have moved in successfully, 28 people were inpatients. Phase 2 – Homes for 6 people are being created through 3 projects that are in progress. The property adaptions and refurbishment work will be finalised in Q4 2025/26. Phase 3 – Homes for 37 people, through a further 9 projects, are working through feasibility stages. Capital funding is secured for most of these projects, and they will mobilise in 2026/27 and 2027/28 .Funding – A total of £17.3m in capital funding has been applied for with over £10m secured. Savings of £1.4m per annum in support costs to the GM system from the completed projects.

Complex Lives Procurement

The Learning Disability and Autism project procurement process was completed in 2019. Detailed specifications were developed and agreed with GM colleagues for each of the four groups identified. A total of nine support providers were awarded across four lots.The procurement processes were a strategic, multi-agency approach involving self-advocates throughout. The successful providers all demonstrated a strong track record of experience, quality and commitment to deliver the project. This work is supporting GM to work towards the NHSE target to reduce the number of people with a learning disability and autistic people in mental health inpatient settings.

Memorandum of Understanding

A Memorandum of Understanding is in place and has been signed by all ten localities. The core principle of this Agreement is the principle of ‘Own Our Own’. The responsible commissioner remains and will not change irrespective of a move of a place of residence.The new provider framework provides a great opportunity for care and support providers to be part of the GM transformation work, to enable more flexible and innovative commissioning at both a local and cluster level (across borough/GM-wide), to codesign and deliver specialist care, health and support suitable to meet individuals’ needs and personal outcomes.

The focus for Greater Manchester is on delivering:

• An improved universal offer to all adults and older people residing in Greater Manchester via engagement with communitiesand key partners.

• Early Intervention and prevention

• More help to live independently

• A focus on reablement / enablement and recovery

• Providing alternatives to a reliance on long term residential care

• Safe, good, quality long-term care

• Protection and safeguarding of vulnerable adults

• A targeted integration of services with Health Partners.

Commissioning Activity

The framework has already been used by several locality commissioners for mini competition, market engagement and commissioning for individual packages of care and support. Over the next 12 months, three localities will be tendering and awarding large contracts, using a strategic commissioning approach, for supported living provision. There are also several GM projects planned, these include complex lives, preparing for adulthood, complex mental health and complex dementia.The GM Adult Social Care transformation have implemented a process to monitor activity and provider quality concerns.

Coproduction

We are committed to continuous engagement with people who receive support, and carers and family members of those who receive support, to develop provision and to understand their experiences, their expectations and how care and support can be further improved to ensure they receive a high quality service and are enabled to live a fulfilled life in their home and in their local community We want to ensure that individuals who get care and support have a voice and are at the heart of service design, delivery , and evaluation through a co-commissioning approach.

How Innovative is your initiative?

It is a unique GM commissioning model and an enabling model for social care and health commissioners. This great work to support people out of hospitals, continues under the new framework and is very much one of our key priorities. Utilising the new framework has enabled the project to grow in scope and to diversify into other workstreams.

Overall achievements and benefits of this framework approach:

• This ground-breaking framework was achieved by co-design, collaboration agreement across 10 GM Localities, led by citizens, providers and commissioners.

• It has now encouraged collaboration across commissioners within GM, improved efficiency and reduced procurement time.

• Feedback from people who draw on services and providers has been excellent, providers are really encouraged by the fact that they apply once and have access to all of GM opportunities, this saves them time and resources which can be better directed towards providing care.

• Delivering flexibility for new market entrants

.• Soft market testing has allowed commissioners to engage and innovate with providers to meet needs.

• Providers have all signed up to the GM Health Charter .

• All providers have committed to deliver social value. The working group provided knowledge, experience and decision making around the aims, scope and specification of the framework.

Opportunities

Through this programme we are

• Enabling more people to live well at home (wherever that may be) through access to the right support, at the right time, in the right place

• Enabling people to have choice and control over where their care and support close to their own community

• Improving the GM and local ‘offer’ to people with complex needs by shaping a diverse market with a range and concentration of services, assets and infrastructure.

• Increasing joint working and collaboration across the system, improving communication and information sharing.

• Further integrated and co-ordinated service responses

Objectives

A key objective of the framework is that it will be a tool to enable health and social care commissioners to grow, shape and support the market and better manage demand for specialist provision, providing consistency of available providers across GM and support people to live well at home and as independently as possible with better lives and better outcomes.

The objectives of the care and support awarded under the framework will be to:

• Ensure that the individual is at the centre of planning and commissioning and that care and support is developed flexibly and supports great outcomes.

• Care and support is needs-led rather than diagnostic led which allows support regardless of diagnosis with a clear focus on need and a recognition that need will naturally fluctuate over time and in response to circumstances.

• Ensure that any interventions are developed through clear person-centred planning approaches.

• Ensure that active positive behaviour support plans are in place, which consider proactive approaches to manage risk and crisis whilst ensuring that any reactive plans are proportionate and least restrictive to manage need. Ensuring that the principles of positive behaviour support are embedded across the staff team.

• Support individuals in their own home (where possible) to maximise their independence

• Enable individuals to develop meaningful friendships, relationships and networks of support in their local communities.

• Support and promote individual choice and control to assist people to realise their potential and aspirations.

Care cubed

All GM localities have paid for a placed based Care Cubed licence, this is an online tool to support open and transparent negotiation of costs for complex placements.It provides a clear baseline of the cost of care to support and enable robust negotiation and gives a structured, person centred, approach to recording needs and outcomes.

What are the key learning points?

For many years commissioners and providers have been grappling with support solutions for people deemed to have very complex needs. We have seen some pockets of best practice but in most instances, we have seen reactive commissioning, alack of consistent co-design, and traditional contracting models at best which do not always result in the best outcomes for people. Across GM, we are changing the way we traditionally respond, building on significant and innovative opportunities to reviewand improve the way we deliver support solutions for people considered to have complex needs. As part of the Transforming Care Programme, the complex lives programme has created homes for people in the community.

The project has enabled the discharge of a significant number of people out of long stay institutions into their own homes in GM.This programme is supporting commissioners to increase capacity to support people in the community, close to family and friends and where they want to be. We work with people that localities have struggled to find support solutions for, via an additional pathway when all other local pathways have been explored. The initial proof of concept has been successful with the Learning Disabilities and Autism workstream and initial work has started on Preparing for Adulthood, Complex Mental Health and Complex Dementia workstreams.

In April 2025, GM launched the GM Provider Framework – Supporting People to Live Well at Home  programme, with an objective of moving to one GM procurement framework to create a strategic commissioning framework that brought together scope of both existing frameworks and areas where we knew there was unmet need.The new GM framework was a collaborative project with a large working group representing the different health and care commissioners across GM. An in-person workshop was held in October 2024 for commissioners and practitioners, and a provider event was held in November 2024. We received constructive and practical feedback that helped shape the scope, procurement documentation and process and the procurement process was started in December 2024.The evaluation started in January 2025, an evaluation team of 37 representatives from across Greater Manchester evaluated over 600 bids.The scope of this framework includes seven specialist areas:

• Learning Disabilities

• Neurodivergent

• Complex Lives

• Complex Mental Health

• Complex Dementia

• Individualised Commissioning Including Continuing Health Care (CHC)

• Preparing for Adulthood

The framework covers the following types of service: Residential, Nursing, Supported living, Day opportunities, Homecare, Outreach, Respite and Short breaks, Supported Employment and Volunteering. The framework enables providers to develop and maintain effective working relationships with partner organisations. The partner organisations are10 Local Authorities and 4 NHS Trust.The framework is for high-quality providers who can provide person-centred and outcome-focused care and support. Providers must adopt a strength-based approach, supporting people to recognise and achieve their full potential, whilst also working towards increased levels of health and wellbeing. We think this is the first strategic commissioning framework that has been co-designed across health and carecommissioners, with providers, that spans the geography of a Mayor city region and Integrated Care System.