- Posted:Tuesday 20 October 2015
I think the question is whether we can achieve a clinically and financially sustainable health and social care system which delivers better outcomes and better patient experience and involves greater democratic involvement and accountability. In Greater Manchester, the problems that we have, that everybody has around clinical and financial sustainability are the same and written large, some serious health problems, not just the traditional ones around life expectancy but also the level of unemployment and the level of inactivity of people on welfare benefits. That for the context for the devolution journey that we are now embarking on…
This might feel like a flash in the pan, it might feel like it’s come from nowhere. It’s actually come from a long history of integrated and joint working between the partners. The ten Local Authorities in Greater Manchester have been working as a combined Authority for a decade. The CCGs preceded by Primary Care Trusts have been working on a Greater Manchester footprint for that length of time and I just thought I’d highlight, if I may, three of the key principles which underlie our agreement and our work. The first one is that decisions about Greater Manchester should be made with and by and in Greater Manchester. The second principle is about shifting our focus towards an emphasis on people and place and what works for the communities within Greater Manchester rather than just on what’s right for the individual organisations. The third key principle is about seeing beyond just health and social care. Really this is about the breadth of integration and the breadth of the opportunities. Our focus, our vision, our aim is to achieve the greatest and fastest possible improvement to the health and wellbeing of the 2.7, 2.8 million people of Greater Manchester.
We will have a budget of £6.2 or £6.3 billion. We’re trying to get it to £6.4 or $6.5, we’ll see. And we represent over five per cent of the NHS, and it’s that scale, that fact that we are able to where necessary and where relevant speak with one voice that I think has particularly caught the attention of many of our national bodies, be that government, be that NHS or Local Authority bodies, but also business and wider agencies as well. It’s not easy to get out on the street and have an interesting conversation with most people about devolution. However excited I might think about it, it’s not a conversation starter. What is a conversation starter are some of the things that we have been doing such as guaranteeing that by the end of this calendar year, everybody who needs to see a primary care professional seven days a week will be able to do so in each of the ten boroughs in Greater Manchester.
I think they’re interested and motivated, the population, by knowing that through some of the changes we’re bringing about through our Healthier Together programme which precedes devolution that we are able to improve the expectation of survival from emergency surgery so that 300 more people will live every year as a result of concentrating emergency general surgery in four hospitals in Greater Manchester rather than the current ten. In the last few weeks, our ten councils and twelve CCGs have individually and then collectively agreed that there will be a level of pooling of health and social care budgets at a scale that I’ve never seen before in my 25 years. I mentioned that our total budget is $6.2 billion, our total budget, over £6 billion. Of that, at least £2.7 billion is being pulled in health and social care arrangements in each of our ten boroughs collectively. Each of our ten boroughs are working together, not just the CCG and the council but the trusts, the voluntary organisations and others, and some are better than others. I wouldn’t pretend it’s perfect, but a real focus on a place-based view of what works for that local population. Locality plans in themselves are not going to provide us with the pace of change we need to reduce or eliminate the financial and other challenges that we have. So we think we need to have a series of Greater Manchester game changers, things that are significantly different to what we have ever tried before in order to deliver on our outcomes.
I mentioned our population health work. We will need to deliver that at scale, both locally and across GM in a way that has been aspired to by Wanless and other worthy reports in the past. We need to deliver that on the ground. Secondly, we will almost certainly be pursuing an agenda around standardisation and improvement of services. The variation that we have between services whether that’s in primary care or in hospitals is unacceptable and we need to find ways of changing that situation. Is devolution the answer? We’re having a real go at finding out. Many thanks.