Delivering clinical and financial

sustainability across a £6 billion health

economy

Donna Hall, Chief Executive, Wigan Council

Dr Ranjit Gill, Chief Clinical Officer, Stockport CCG

Scale of the Challenge

8 July Budget

• Health and social care leaders from across Greater Manchester are now coming together as part of

the transition to their control of their £6bn health and social care budget. • Together they are making progress on work to extend seven day access to primary care, radically

upgrade prevention and public health, help those with mental ill health into work and make Greater Manchester’s Academic Health Science System a national leader.

• By the end of this year they will have a Greater Manchester Strategic Plan in place to show how they will deliver a clinically and financially sustainable set of health and social care services for the people of Greater Manchester. The production of the Strategic Sustainability Plan will be aligned with the Comprehensive Spending Review (CSR) process that applies to NHS, Public Health

and local authority social care funding.

Scale of the Challenge

Progress to date

Through devolution significant progress has already been made in the following areas: • A commitment that by the end of 2015 everyone living in Greater Manchester (GM) will have same

day access to primary care, supported by diagnostic tests for seven days a week. This is alongside a commitment to transform and integrate how services are delivered as part of non hospital care. There are agreed quality standards that will apply across GM.

• A decision on the reconfiguration of Acute Services through Healthier Together. On 15 July there will be a decision on which hospitals will work in partnership as single services and which fourth hospital will specialise in general surgery and emergency medicine as part of that single service. The alliance to achieve this has been built by being able to tell the whole story of the reconfiguration of health and social care services in each locality and not just focussing on the current role of hospitals thus giving a strong platform for the delivery of future change.

Progress to date

• Delivery of a Memorandum of Understanding (MoU) for Public Health – On July 10, a MoU was signed between GM, Public Health England (PHE) and NHS England (NHSE) supported by key partners including NHS commissioners and providers in GM and Blue Light Services. The agreement creates a framework by which partners will create a single unified public health leadership system capable of contributing to a transformational and sustainable shift in the health and well-being of the population.

• Delivering the only accelerated health science centre outside of London and the South East. There will be a new Academic Health Science System (AHSS) partnership with its own governance and a prospectus setting out changes that will be delivered. Work continues to establish an over-arching Board to facilitate alignment of the work of partner organisations to respond to health and well-being needs of the conurbation and capitalising on research and innovation assets across Greater Manchester. This will deliver a smooth and integrated pathway from discovery science and innovation, through experimental medicine and clinical research to reliable and consistent adoption and diffusion.

• Early priorities include integrating and scaling up health informatics to cover the entire

GM population, enhance personalised/stratified medicine capabilities and develop clinical trials capacity and effectiveness.

The Vision for Public Health

The focus will be on making the case for the ‘economics of prevention’ demonstrating that the link between public health, employment and early intervention outcomes. There are five major transformational programmes of work: • Public health, reform and growth – Making the most powerful case yet for the ‘economics of

prevention’ demonstrating the link between public health, employment and early intervention outcomes and setting this out in a joint submission to the Spending Review

• Nurturing a Social Movement for change - Enabling people to make their own informed life-style

choices and creating new platforms for full engagement of GM residents • Starting Well – Early Years – the scaled implementation of the GM early years model to improve school readiness and addressing long term determinants of public service demand

• Living Well - Work and Health - aligning public health intervention to wider public

service reform tackling complex dependency and supporting residents to be in sustainable and good quality work

• Ageing Well - Ageing Well – Setting up a Greater Manchester Ageing Hub to support

age-friendly communities and environments, and scaling work on dementia friendly communities, supporting those with dementia to remain connected to their communities and in control of their lives for as long as possible

The Vision for Public Health

Early implementation priorities: • Supporting the implementation of the GM health and social care devolution early

implementation priority of mental health and worklessness. • Reducing the impact of hypertension. • Increasing the impact of Health Checks through more consistent implementation

across GM. • Developing enhanced outbreak management and response arrangements. • Alcohol Licensing - Securing (as part of the wider devolution agreement) a 5th licensing condition associated with harm to health.

The Vision for Public Health

• Accelerating the learning across Greater Manchester from the Well North pilot sites, aligned

to the learning from the GM public service reform programme of complex dependency. • Working with the GM Fire and Rescue Service to convert the GMFRS Home Safety Check

into a 'Safe and Well' Assessment tool, and extending the work of the GM Community Risk Intervention Teams to cover all ten districts/localities of GM.

• We will build on our experience and evidence base from the development of the Early Years

Model and Working Well and combine this with the expertise from PHE to clearly set out the case for change.

The Investment Fund

• The Greater Manchester Health and Social Care MoU signed on 27 February 2015 states that “We commit to the production, during 2015/16, of a comprehensive GM Strategic Sustainability Plan for health and social care. This aligned with the Five Year Forward View will describe how a clinically and financially sustainable landscape of commissioning and provision could be achieved over the subsequent five years, subject to the resource expectations set out in the Five Year Forward View appropriate transition funding being available and the full involvement and support of national and other partners.”

• The proposal will set out our plans for improving outcomes and achieving clinical and financial sustainability and will describe how upfront investment, alongside the radical changes proposed, can enable the foundations to be in place within the five year CSR process, to achieve financial balance.

The Investment Fund

• It is important that this outline plan also demonstrates how fiscal neutrality can be achieved during the CSR period. The GM health and social care economy is not in financial balance and the gap is projected to widen. What this work will need to demonstrate is how additional one-off investment in the early years of the CSR period will enable the gap to be closed and financial balance to be achieved. By neutrality it is important that the ultimate saving between the projected deficit and achieving financial balance outweighs the level of one-off investment required.

• The recent July Budget Announcement confirms that “By the end of this year they [GM] will have a Strategic Sustainability Plan in place to show how they will deliver a clinically and financially sustainable set of health and social care services for the people of Greater Manchester. The production of the Strategic Sustainability Plan will be aligned with the Spending Review process that applies to NHS, Public Health and local authority social care funding.

GM Objectives: Transforming Integrated Community Based Care and Support

Planned Progress by December 2015

• Dementia (September) - Work continues to define the next steps and key deliverables for this project between the project lead and the GM Director Adult Social Services lead for dementia to consider how to engage the wider GM system to determine what a wider transformational programme on Dementia could achieve. The aim is to establish a development plan for integrated services for dementia care across GM. This will feature a Salford led pilot of a whole system change for people with dementia to scale across the whole of GM over the next five years.

• Mental Health and Work (November) - Announcement on impacts on mental health improvement arising from the Working Well pilot and achieve agreement on a new more intensive and integrated delivery model for supporting unemployed residents who have a mental health-related barrier to work by November 2015. This will build on the successes in the Working Well pilot and achieve agreement on a more intensive delivery model for supporting GM residents who have a mental health related barrier to work.

Planned Progress by December 2015

• Workforce Pilot (December) - Work continues to be progressed with GM HR Directors to develop the passport to facilitate flexible working across organisations and to align the work to review agency/locum costs with national discussions and directives. By December this aims to deliver an agreement across providers to adopt common standards for pre-employment checks and statutory training and agree common rates for specified targeted locum and agency staff.

• Child and Adolescent Mental Health Services (CAMHS) – Work to agree and develop a unique, and at scale system wide enabler to transforming Children and Young People’s Mental Wellbeing services continues to be developed across the GM system and an update will be provided to the September Programme Board. This will adopt an evidence based approach to developing a GM co-ordinated approach to transformational commissioning and improve access and referrals.

Financial Work

• Confirm the baseline funding (£6.2bn) alongside arrangements for related funding such as from PHE, HEE and DH

• Calculate the scale of the financial gap over the five year period until 2020/21 and then:

• Extend until 2020/21 • Specialist commissioning • Updated provider deficit position • Updated local authority position

Financial Work

• Closing the gap – The impact of Healthier Together and further proposals impacting on the delivery of acute

services – The impact of the proposals in the Locality Plans from the delivery of integrated health and

social care out of hospital services – Contribution of targeted prevention and public health – including planned work with PHE – Utilisation of benchmarking and evidence from organisations such as Kings Fund

Contributions from areas such as Mental Health into Work, Complex Dependency, – use existing CBA and related work

– Delivery of the enablers e.g. from Capital Estates and IM&T, Workforce, Contracting and Procurement

• Quantifying the investment requirements to achieve the transformational change in the

timescales required

Thank you for listening

Any questions?