Whats happening in Greater Manchester and why does

What’s happening in Greater Manchester and why does it matter to you? (a very short guide!)

NHS Long Term Plan • The NHS Long Term Plan (published 7 th January 2019) lays out the path for the NHS over the next decade; • Many of the initiatives in the Plan mirror those underway here – including on population health, integration and digitally-enabled care; • Whilst increases in NHS funding are welcome, it is vital that sustainable financial settlements are agreed for both Social Care and Public Health and Care integration is undermined without this long-term financing; • Although lots on personalised care – there could be more on the role of community groups and organisations – and how they can support people in a non-medical model; • Some mentions of the VCSE in the document – but could have gone further • GM Prospectus gives us opportunity to go beyond the LT Plan in GM.

The GM Prospectus • We want to go beyond other integrated care systems to create a comprehensive population health system based on the capabilities and hopes of our residents; • We want to offer a compelling picture of how the intentions of the NHS Long Term Plan are already being delivered, and can be built upon, in the context of Greater Manchester as a place with a vision which connects the whole of public service, the VCSE, the business sector, academia and civic leadership; • The Prospectus explicitly states: The VCSE sector should be part of the fabric of public services and public services should be delivered with local citizens, businesses and communities. This also means a radical change in the way we commission and partner with communities and the VCSE sector, we work as one across public services and we work as one with communities; • The infrastructure we have in place also provides us with the opportunity to enact a public-service wide response to the ambitions in the Plan. For example, on poor air quality.

Wider National and GM Strategies • National influence: the new NHS long-term plan; the Social Care Green paper; the Government Spending Review in 2019. • The GM Independent Prosperity Review. Guided by an independent panel of economic experts this review is updating GM’s evidence base and is expected to provide the analytical underpinnings for discussions with Government generally and the local industrial strategy specifically over the coming years. • The GM Local Industrial Strategy. This will be a jointly agreed strategy with Government, setting out how GM will maximise its contribution to UK productivity and earnings growth. It is due to be agreed by the end of March 2019. • The Transport Delivery Plan 2020 -2025. This sets out our plans for the next five years to deliver the Transport 2040 future vision for “world class connections that support longterm sustainable economic growth and access to opportunities for all” • The White Paper on the GM Public Services Model. This will set out how we will deliver the 6 features of the GM public service model and is expected to be published in Spring 2019.

Population Health

GM Population Health Plan – Programme Overview £ 0. 5 m £ 2. 1 m £ 1. 6 m £ 2. 4 m £ 2 m £ 1. 8 m £ 1. 3 m £ 4. 5 m £ 0. 6 m £ 5. 3 m £ 2 m £ 0. 2 m £ 2. 1 m

Person & Community-Centred Approaches (PCCA)

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Person and Community-Centred Approaches in Greater Manchester 10

Approach Selected source of evidence High level findings Patient activation, self management and education Vanguard sites Somerset: projected 6% reduction in total NHS budget Fylde: 21% reduction in non elective admissions, 17% in elective admissions Asset based approaches – using community structures Local Area Co-ordination network – the Swansea University Study Financial benefits of £ 800 k-£ 1. 2 m (benefit cost ratio between 2: 1 and 3: 1), expected benefits rising to between 3: 1 to 4: 1 when embedded within communities and partnerships Referral to VCSE to access community support Rotherham, Sheffield Hallam University 11% drop in hospital admissions, 17% drop in A&E attendances (51% and 35% respectively for under 80 s receiving long term VCSE support) Person centred care and support Partners 4 Change and Trafford MBC Staff productivity, numbers seen increased by around 67% Rate of care packages halved Staff morale – ‘energy lifted and liberated’ Social Action and Peer support Altogether Better/York Health Economics Consortium A positive social return on investment of up to £ 112. 42 for every pound invested For people with particular long-term conditions Realising the Value £ 2 k saving/person reached /year achievable in first year Social Prescribing University of Westminster 28% reduction in demand for GP services 24% fall in A&E presentations The APPG report on Arts, Health and Wellbeing 27% reduction in hospital admissions 37% drop in GP consultation rates Personal Health Budget Pilot Sites For people with complex need, reduced costs estimated to be around £ 3. 1 k person primarily in-patient costs Integrated Personal Budgets Sources include: New Care Model sites, NHS England; SCIE NICE; National Voices; TLAP as host to around 50 organisations inc ADASS; Nesta, New Economics Foundation, RSA; Public Health England; The Health Foundation, Kings Fund; All Party Parliamentary Group on ‘Creative Health’; Royal College of General Practitioners; Altogether Better; Academic Institutions including Newcastle University, Sheffield Hallam University, Swansea University, University of Westminster

Local Care Organisations

The building blocks of transformation • Local care organisations coordinate delivery of integrated care in each borough • Boroughs are made up of smaller neighbourhoods GP practices working with other health and care professionals • Standardisation across hospital sites and more care in the community, closer to home • A single local commissioning function in each borough plus a GM Commissioning Hub • Core characteristics include a focus on the VCSE sector

Example of Neighbourhood Models as part of LCOs Adult Social Care Community Health Services Integrated Commissioning: Pooled Health & Social Care Budget Mental Health support GP Practices Voluntary Sector Community Link Workers Wider public services Children’s Services Neighbourhoods 30, 000 -50, 000 population within LCO

LCO themes • LCO Development Framework agreed by partners in the system • Four Core Themes: 1. Enable conditions to be managed at home and in the community; 2. Secure the full range of public service partners to providing early help and prevention 3. Support individuals and communities to take more control over their own health 4. Take full responsibility for the management of the health and wellbeing of a defined population.

Public Service Reform (or reform of support and services for the public? )

The 6 Key Features of the Operating Model for all Public Service, Health and Care Organisations in Greater Manchester 1 • All services share the same service delivery footprints. • Resources and Staff are aligned. 4 • Sharing our financial resource across the system and commissioning to align frontline resources. • Working towards a place-based budget. 2 • Integrated leadership and governance structures across the system. • Joint decisions making. • Leading for the people and place as opposed to organisation. 5 • Having a single transformation programme across all disciplines • Bringing multiple delivery models together into a single function 3 • One workforce functioning together, unrestricted by role titles or organisational boundaries. • Staff given ‘permission to change the system’ through culture, policy change and supporting structures 6 • Mechanism to remove national policy barriers to integrated working through future devolution. • A single conversation with Government

From Principles to Practice Our principles have provided the foundation of the Greater Manchester model. • A new relationship between public services and citizens, communities and businesses that enables shared decision making, democratic accountability and voice, genuine co-production and joint delivery of services. • An asset based approach that recognises and builds on the strengths of individuals, families and our communities rather than focussing on the deficits. • Behaviour change in our communities that builds independence and supports residents to be in control. • A place based approach that redefines services and places individuals, families, communities at the heart. • A stronger prioritisation of well-being, prevention and early intervention. • An evidence led understanding of risk and impact to ensure the right intervention at the right time. • An approach that supports the development of new investment and resourcing models, enabling collaboration with a wide range of organisations. It is now time to move from principles to practice. #GMtogether

Our Role as Leaders • Develop a single unifying philosophy which is optimistic, simple and applies across the place to everyone. • Keep telling this story with illustrations every day to everyone with humility. • Create political and organisational support for a radical new model. • Build a strong, cohesive and high energy team. • Constantly listen harder to residents, to staff to community groups. • Build a demand management not a budget strategy. • Build trust with staff and community to allow them to innovate and for it to be ok to be courageous. • Switch the 80% to investment in people not processes. • Relationships make more difference than structures, projects and pilots. #GMtogether

Other topics • • • Mo. U and Accord signed with the VCSE Representation Engagement work e. g. Big Alcohol Conversation Equalities Workforce Wider GM programmes e. g. GM Moving More information: ben. gilchrist@actiontogether. org. uk | 20