“implications for health and social care” · •dementia pilot •workforce policy alignment...
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DevoManc “Implications for Health and Social Care”
David Jones
Consultant General and Colorectal
Surgeon
University Hospital of South Manchester
RCS North West
Director of Professional Affairs
@jonesthesurgeon
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Conflicts of interest
• RCS North West Director of
Professional Affairs (DPA)
• Member of Healthier Together
• Clinical Advisory Group
• Consultant Surgeon
• Wythenshawe Hospital (UHSM)
• Judicial Review of HT decision by
Consultants (9th and 10th December 2015)
for Wythenshawe Hospital to be a local
rather than Specialist site
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@GMHSC_Devo #GMDevo
To ensure the greatest and fastest possible improvement
to the health and wellbeing of the 2.8 million citizens of
Greater Manchester
Political background
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Manchester City Council
96 councillors
(96 Labour)
Greater Manchester (DevoManc)
10 Metropolitan boroughs
8 Labour
1 Conservative
1 Liberal Democrat
• Greater Manchester
Population 2.8 million
£6b Health and
Social Care budget
Similar budget and
population size to
Wales and a little bit
bigger than Anglesey
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• 2. 8 million population
• £6b Health and Social
Care budget
27th February 2015
Manchester Town Hall
@GMHSC_Devo #GMDevo
Who will be responsible?
10 Borough councils
CCGs
Interim Mayor
NOT responsible for health
Risk assessment
• Central government will still have the power to cut
local authority funding, as it already does in the
name of austerity, but no responsibility when
councils have little choice but to cut health care
services
• Ultimately most services are locally delivered by
relatively autonomous professionals whose
commitment to a new strategic vision needs to be
secured
• Guardian: March 2015 9
Early implementation priorities
for DevoManc • 7 day access to primary care
• Academic Health Science System
• Dementia Pilot
• Workforce policy alignment
• Public Health Programme
• Healthier Together
• Mental Health and Work
• Children and Young Peoples’ Mental Wellbeing
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Real-terms expenditure
(£s billions) % change
2010–11 2014–15
England
Health 105.3 109.9 +4.3%
Social
Services 24.6 21.8 -11.5%
Wales
Health 6.48 6.35 -2.0%
Social
Services 1.60 1.58 -0.8%
Institute for Fiscal Studies
• Welsh Government
• less protection to health
budgets
• Smaller cuts in social care
• Institute for Fiscal
Studies 2015
• Cardiac surgery waiting times!
• Highlighted by Welsh RCS
Professional Affairs Board
Differences with Devolution
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Plans for Manchester
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By 2020
64,000 lees with chronic conditions
10% less visits to urgent care
6000 less diagnosed with cancer
25,000 with mental illness benefit
from better community care
18,000 children better supported
by local services
700,000 with chronic conditions able
to manage own health
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All hospitals in Greater Manchester with an
acute take are in the “red"
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North of England
Commissioning Region
July 2015 – Sept 2015
4919 cancelled on the day
NHS England Statistics
Delayed discharges awaiting
social care support in the community
Do we need to spend more on
Social care and less on healthcare?
Social care budget cuts in the North East
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Priority 1
“Advance standards and reduce
variability in patient outcomes”
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Wide variations in treatment of
haemorrhoids!
Commissioned activity for haemorrhoids
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5 fold variation
In Greater
Manchester
Adjusted 2 year mortality rates by Trust
Reflects all aspects of care?
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Wider variation in outcomes
North West: 2 year adjusted mortality
Is it still the same teams operating?
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34.7 33.9
30.6
28.6 27.9 27.8 27.2 26.9 26.7 26.1 25.9 25.1 24.9 24.2
22.7 22 21.6 20.9 20.7
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14.3
0
5
10
15
20
25
30
35
40
45
I N E T U M Q A C L J O R F B V D H S P G K
2 year mortality
2 year mortality
North West - Rectal cancer:
APR rates
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0
5
10
15
20
25
30
35
40
45
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J A M D H R C N T F Q E L B P U K I O S G V
Rectal Cancer – North West
Stoma rates at 18 months
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0
10
20
30
40
50
60
70
80
E A Q D F B G U C J L T I V M S R P N H K O
Stoma at 18 months
Rectal cancer: North West
Variation by in APR and stoma rates by Trust
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• 6 fold for APR rate
• 1.5 fold for stoma
• Quality of life with stoma
may differ if an end
colostomy or “temporary”
loop ileostomy
• Quality of life after
anterior resection?
• Patient selection
• MDT
0
10
20
30
40
50
60
70
80
J A M D H R C N T F Q E L B P U K I O S G V
APR Stoma at 18 months
Large bowel obstruction
Surgery or stenting
Temenos (A sacred piece of ground)
Anish Kapoor
Middlesborough
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Clinical needs
Value for money
We do a lot of operations
Are they all needed?
0 50000 100000 150000
Hernia
Hip replacement
Knee replacement
Cholecystectomy
Tonsillectomy
PROMs – Improvement rates (hscic data)
Worsened Improved
Priority 1
“Advance standards and reduce variability in
patient outcomes”
Devolution will focus minds?
Early implementation priorities
• 7 day access to primary care
• Academic Health Science System
• Dementia Pilot
• Workforce policy alignment
• Public Health Programme
• Healthier Together: Single service provision
• Emergency, Acute Medicine and General Surgery
• Mental Health and Work
• Children and Young Peoples’ Mental Wellbeing
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Healthier Together • 4 Single services
• Specialist and Local General Hospitals
• High risk elective and emergency general
surgery on the Specialist site
• Staff work and train in a single service rather
than a specific site
• Emergency medicine, Acute Medicine and
General Surgery
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Which hospitals are General and
which are Specialist?
There are
8 options
Hospitals not under review
Hospitals under review
There are 10
hospitals in
scope
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Healthier Together
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“DevoManc”
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