DEVOLUTION & HEALTH & SOCIAL CARE REFORM

Warren Heppolette

Potted history of health devolution for GM

• The opportunity is a distinctly Greater Manchester one, building on our own track record

• Discussion with Chancellor regarding the devolution of health and social care in September 2014

• Very positive response and suggestion of a business case for investment

• Initial focus was on this business case and the opportunity to receive some additional non-recurrent funding

• NHS England initially surprised but subsequently very enthusiastic

• A bigger and more comprehensive devolution agreement between Greater Manchester and NHS England now a real prospect with agreement to work together set out in a memorandum of understanding.

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The devolution of health and social care has made national headlines; illuminating both the opportunity but also the expectation

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Health devolution for Greater Manchester 25 February 2015 Greater Manchester is to become the first region in England to get full control of health spending.

Greater Manchester £6bn NHS budget devolution begins in April 27 February 2015 Greater Manchester will control a combined NHS and social care budget of £6bn Greater Manchester will begin taking control of its health budget from April after a devolution agreement was signed by the Chancellor George Osborne.”.

It's a historic day for Manchester, but not a 'town hall takeover' 27 February, 2015 | By Crispin Dowler NHS insiders in Greater Manchester have been pleasantly amazed by the speed at which negotiations progressed leading up to today’s historic agreement to devolve and integrate £6bn of health and social care spending for the conurbation.

Revealed: Details of £6bn Manchester health devolution plan 25 February, 2015 | By James Illman Radical plans for Greater Manchester to take control of £6bn of health and social care spending will be overseen by a new statutory body from April 2016, according to draft plans obtained by HSJ.

What does Devolution offer?

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The overriding purpose of the initiative represented in this Memorandum of Understanding is to ensure the greatest and fastest possible improvement to the health and wellbeing of the 2.8 million citizens of Greater Manchester (GM). This requires a more integrated approach to the use of the existing health and care resources - around £6bn in 2015/16 - as well as transformational changes in the way in which services are delivered across Greater Manchester.

……A focus on people and place

Objectives

– Improving the health and well being of GM residents from early age to elderly - recognising will only be achieved with a focus on prevention of ill health and promotion of well being

– Moving from having some of the worst health outcomes to having some of the best and closing the health inequalities gap within GM and between GM and the rest of the UK faster

By:

• Integrating care for a more holistic, co-ordinated approach

• Putting experience of patient, carer and families at the centre of how services are organised and delivered.

• Making best use of existing budgets, including to improve performance around reducing pressure on A&E and avoiding hospital admissions, where appropriate.

The MoU

• Framework for delegation and ultimate devolution of health and social care responsibilities to CCGs and local councils in GM

• Sets out process for collaborative working from April 1 2015 and work needed during 2015/16 to achieve full devolution and/or delegation in April 2016

• Agreement for parties agree to act in good faith to support the objectives and principles of the MoU for benefit of GM patients and citizens

• Includes all local authorities, all GM CCGs and NHSE

• GMNHS Trusts, Foundation Trusts and the NW Ambulance Trust issued letters of support

• Allows GM to reshape how health and social care services are delivered - estimated budget of £6 billion

• Services will stay as part of the NHS or Councils but will be tailored to reflect needs of residents

• CCGs and Councils will keep existing accountabilities, legal obligations and funding flows – ie responsibility for NHS funding stays with NHS and for local authority funding with local councils (not CA)

Principles

• GM remains within NHS and social care system - uphold standards in national guidance and statutory duties in NHS Constitution and Mandate - and for delivery of social care and public health services

• Decisions will be focused on the interests and outcomes of patients

and people in GM - organisations will collaborate to prioritise those interests

• Decision making underpinned by transparency and open sharing of

information

• From 1 April 2015 ‘all decisions about GM will be taken with GM’

• GM will work collaboratively with local non GM bodies and take into account the impact of their decisions on them and their communities

But devolution is the mechanism, not the master…

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What are the issues we need to respond to…?

….devolution can be the trigger for greater and necessary positive reform

A growing ageing population

Poorer health & growth in chronic conditions

Instability & fragmentation in the health & care system

Consequences • Unplanned,

Haphazard change

• Poorer care and treatment

• Difficulty in meeting future health needs

• Failing the health & care workforce

Increasing pressure on health & social care

What does radical reform look like?

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• Shifting the balance of investment towards proactive, early help and away from a crisis response

• Health & care defined by an

approach based on prevention

• Intelligence led, highly targeted preventative action based on a deep knowledge of our communities and their strengths

• More integrated public services responding to all forms of vulnerability

• Increased healthy life expectancy

A different approach to reform…

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“One of the great strengths of this country is that we have an NHS that – at its best – is ‘of the people, by the people and for the people’. Yet sometimes the health service has been prone to operating a ‘factory’ model of care and repair, with limited engagement with the wider community, a short-sighted approach to partnerships, and under-developed advocacy and action on the broader influencers of health and wellbeing. As a result we have not fully harnessed the renewable energy represented by patients and communities…” (NHS Five Year Forward View)

Making it happen

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EVIDENCE EXAMPLE

In Wigan a new asset based approach to communities and individuals has been trialled and rolled out across the Borough. Deeper conversations with residents enables greater insight and understanding of what is important to the individual resulting in innovative alternatives to formal care that can be accessed through a personal budget. It also enables the identification of root causes of anxiety and addresses wider issues such as social isolation. It ensures that consideration is given to carers and wider support networks. Initial evaluation of the work indicated 76% of the cohort did not require any further social care support, 56% were not in services 6 months later and 51% were still independent 12 months later.

Overarching shift from dependence on traditional health and social care services to enabling independence and self reliance

• ‘Different conversations’ with residents to better understand individual assets, recognising strengths, gifts and talents.

• Connecting to and building community capacity to respond to needs:

- Mapping and utilisation of community assets

- Community hubs and micro enterprises

- Use of new technology and value exchange

- Step change in volunteering

• Developing new ways of working to deliver the above