Warren Heppolette: Transforming health and care across Greater Manchester

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  • Posted:Thursday 03 May 2018

In the closing keynote address from our 2018 accountable care summit, Warren Heppolette (Executive Lead, Strategy and System Development, Greater Manchester Health and Social Care Partnership) talks about transforming health and care across Greater Manchester.


If you want to maximise the health potential of the population, an awful lot of what you’re going to touch is non-medical. Making sure that people can find and keep good work. Making sure that children start school ready to learn and ready to thrive, a shift from a reactive crisis driven health system, something that’s defined by its ability to kind of provide and coordinate reliable early help. It would be lovely just to drive transformation but the bottom line is, and I’m afraid we’re doing this in an incredible headwind, both in terms of finance, in terms of you know, the performance of the system. In Greater Manchester we’re doing it across you know ten localities, serving nearly three million people, 33 health and care organisations playing a part in this. We realise that actually the start line for transformation for some organisations, some localities, some individual service areas actually is a distance away. There will be events as well. 

The morning of the 23rd of May last year, and I was given the task of coordinating a mental health response for the victims of the attack at Manchester Arena, and actually within about eight hours I had practitioners from every mental health trust in Greater Manchester. I had representatives from every children’s service department in every council and we set up the organisation, Manchester Resilience up within six weeks of the attack and we’re doing proactive screening, and proactive support to all of the victims, regardless of where they live. I’m not sure we would have reacted that quickly, with that much clarity if we hadn’t been on this journey together around integration. 

I would see part of Greater Manchester’s kind of stratigraphy as an impulse to collaborate. One of the things that we’d confronted over the last year or eighteen months from the election of the mayor in particular, was a specific focus on Greater Manchester’s rough sleeping and homelessness problem, and one of the things that we were able to do quite quickly was kind of convene a conversation so we find out from representatives of the housing providers what they’re going to bring to the table, what can they offer. We find out from fire and rescue service about how they can make use of some of their capacity, assets and resources, and from our part, we were looking to connect our discharge protocols from every hospital in something that didn’t discharge people onto the street. Looking to make sure that homeless people could register with GPs, looking to coordinate our work around outreach support for mental health and substance misuse services. 

So that default in collaboration is something that you can move quite quickly once it becomes practice. You can’t integrate health and social care from Greater Manchester, this has got to be a kind of boots on the ground activity and the task, as much as anything is to ignite the participation of every part and every practitioner and every resident in Greater Manchester. 

We can also collaborate and drive out some of the variation if we take a step in terms of commissioning according to the same set of standards, so we did this last year on the ADHD services, so recognising where actually the points of connection ought to be made. 

Certain institutions generate their own rules, their own norms and if we don’t recognise this collaboration is going to be really, really hard. There is an opportunity, like in airport, to almost operate ourselves as if we were a single entity, but if you think about the ownership of airports, that’s got that bizarre mix of you know, public, private, government but actually the experience of us passing through and having an experience which is partly that of a traveller and partly that of a shopper, gives us a bit of a lesson about the extent to which you can generate something that feels coherent and whole without necessarily having to grab the ownership at any one level. It’s definitely essential for us to integrate health and social care but it won’t answer the big question of how we maximise the health of a defined population and if we get people more comfortable by saying, actually you can join this, just plug yourselves in, come on the journey with us, you’ve got a contribution to make and you’ve got some benefits to take back, we can truly kind of extend where we start to make a difference. 

So we started a conversation a couple of years ago with the schools across Greater Manchester, booked a big room, said do you want to come and see how we can connect in terms of improving the health and emotional wellbeing of schoolchildren in Greater Manchester and 250 representatives of 250 schools came at a moment’s notice, and we started then to think about what can we do in terms of mental health, emotional support provision in schools and we got 31 schools signed up within a fortnight. So suddenly you find that you’re not wrestling just with the financial difficulties in health and care system because there are new assets and resources to be able to plug in. I love the idea of the disruption of saying, we all work for the population and the place, leave your baggage at the door and I’ve realised over the last couple of years it’s not possible. You can’t disconnect people from the baggage and there’s a real risk that it mobilises resistance if people think that you are doing. 

So there is still a real feeling for the providers to meet as providers and the CCGs to meet as CCGs and the councils to meet as councils, as groups and we let all of that happen because actually they like getting stuff off their chest with each other, and then we’ve got more of a chance of saying, so what is it that we can agree on. There is something about the discipline that we need to bring to the programme management and coordination of 320 things across 33 organisations with hundreds and hundreds of leaders playing across it, but at the same time not losing that sense of where the creativity comes from and our biggest lesson I think, over the course of the last year, if you think of the, all that conversation about integrated care organisations and the extent to which it was utterly flattened by discussions about complex contracts and organisation form and PACS and MCP and all that kind of stuff, I think where we’ve seen real action and we’ve seen most of the faster moving benefits to services for residents is where we’ve said no. The key bit here, is that however we integrate, the most meaningful level will be in those neighbourhoods, 30,000 to 50,000 neighbourhoods. It feels like a good point for primary care to connect, it feels like a good point for wider public services to connect but it feels like a good point to be relevant and recognisable to populations across Greater Manchester and what we found is that those people that were struggling with, we’re not really sure what organisation form we’re going to go for and we’ve just said, don’t worry about that, get the stuff happening in the neighbourhood is where we’ve seen pure gold. So not worrying too much about letting the kind of creativity run slightly ahead of the organisations form and contract form because I think that stuff catches up. 

I think, I’m certain I’m out of time. So I hope that was helpful. Thank you very much.