Devo-Manc

Manchester LPC

David ReganDirector of Public Health Manchester City Council

13 May 2015

David Regan

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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 Manchester25 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 April27 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 plan25 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.

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What does Devolution offer?

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……A focus on people and place

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.

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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

• 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.

By

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Greater Manchester Strategic Health & Social Care Partnership Board

Greater Manchester Strategic Health & Social Care Partnership Board

Joint Commissioning Board

Joint Commissioning Board

Provider ForumProvider Forum

Chair, 10 LAs, 12 CCGs, Providers, NHS England, Regulators, Healthwatch, GMCVO

Chair, 10 LAs, 12 CCGs, Providers, NHS England, Regulators, Healthwatch, GMCVO

12 CCGs, LA, NHS England

12 CCGs, LA, NHS England

Acute, Community, Mental Health, Ambulance, Primary Care, Social Care, Public Health

Acute, Community, Mental Health, Ambulance, Primary Care, Social Care, Public Health

GM Governance

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Devolution is the mechanism, not the master

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What is the problem we are trying to solve…?

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

Consequences •Unplanned, Haphazard change•Poorer care and treatment•Difficulty in meeting future health needs•Failing the health & care workforce

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

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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

Wanless for GM 2022…

“Levels of public engagement in relation to their health are high. Life expectancy increases go beyond current forecasts, health status improves dramatically and people are confident in the health system and demand high quality care. The health service is responsive with high rates of technology uptake, particularly in relation to disease prevention. Use of resources is more efficient.”

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• 7 day access to general practice

• Workforce policy alignment

• Public health campaign

• Academic Health Science System

• Healthier Together decision

• Dementia pilot

• Mental health and work

Early Implementation Priorities

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Spring 2015

Summer 2015 Autumn 2015 Winter 2015 Spring 2016

Summer 2016 Autumn 2016 Winter 2016 Spring 2017

APRIL: Process

for establishment

Of Shadow

Governance

Arrangements

Agreed and

initiated

AUGUST: Production of an Outline Plan to support the CSR process which will Include a specific investment fund proposal to further support primary and community care and will be the first stage of the development of the full Strategic Plan.

DECEMBER: Production of the final agreed GM Strategic Sustainability Plan and individual Locality Plans ready for the start of the 2016/17 financial year

DECEMBER: In preparation for devolution, GM and NHSE will have approved the details on the funds to be devolved and supporting governance, and local authorities andCCGs will have formally agreed the integrated health and social care arrangements.

APRIL: Full devolution of agreed budgets, with the preferred governance arrangements and underpinning GM and locality S75 agreements in place.

Timeline to Devolution

MAY-DECEMBER:Announcement of Early implementation Priorities

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What wont change due to devolution?

• The NHS will be responsible for keeping people safe and delivering the NHS Mandate and Constitution to all residents

• Formal consultation will continue to be a legal duty when the NHS considers changes to services and clinicians will continue to be at the forefront of decisions about health.

• Statutory bodies such as Healthwatch will continue to be highly involved in decision making.

• There will be no new layer of government and resources will not be taken away from the front line to support this

• CCGs and Councils will keep their existing accountabilities, legal obligations and funding

• There will be no requirements for NHS reorganisation.

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What will change due to devolution?

• Greater Manchester will be fully involved in decisions which affect GM being considered at a national or regional level this year.

• From April 2016 GM will take those decisions locally. • GM will take local control to work together in new ways to

tackle some of the major health, housing, work and other challenges we face in our region.

• GM will move quickly – we are already planning major projects this year where we believe early progress can be made through the use of the new devolved arrangements. These projects will enable us to test implementation at scale on behalf of NHS England, and to quantify their impact for the eventual sustainability plan.

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Questions & Discussion

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