‘Devo Manc: Bringing Together Greater Manchester’s £6bn

Health & Social Care Budgets’

18th June 2015

MSP CityLabs

Welcome & Introduction

Professor Chris Taylor

Manchester Ecosystem

European Connected Health Alliance Bringing Together the future of Health, Social Care & Wellness

www.echalliance.com / info@echalliance.com

Progress across Europe

The International Network stretches across Europe and North America and is growing!

ECHAlliance Ecosystems:

• Northern Ireland (UK)

• Manchester (UK)

• Athens (Greece)

• Estonia

• Republic of Ireland

• North West Coast, England (UK)

• Yorkshire & Humber, England (UK) • South London (UK) • Scotland (UK)

• Oulu (Finland)

• Barcelona (Spain)

• England (UK)

• Wales (UK)

• Skane, (Sweden)

• France- NICE

• Netherlands

• Turku (Finland) • Kuopio (Finland) • Germany

• Czech Republic

• Valencia (Spain)

• Latvia

• Italy

• Belgium

• Poland

• Denmark

• Slovenia

• USA

• Canada

New In development

No

rthern

Ire

land

Manch

est

er

Cata

lonia

Ath

ens

Oulu

Sco

tland

Est

onia

New

Yo

rk

Eire

NW

Co

ast

Eng

land

Medicines Management

Big Data (health analytics, risk

stratification)

eHealth Strategy (development/

alignment/ delivery)

Integrated Care

Horizon 2020

Chronic disease management (cardio-

vascular health)

E Prescriptions

Health & Eco development

Resourcing opportunities

Diffuse innovation e.g. within NHS

Raising funds (innovative procurement

models, new business models)

ECHAlliance Ecosystem Priority Areas

Support structure for Ecosystems

Bespoke

• Regular calls and meetings held with each Ecosystem team and/or lead

Network

• 6 weekly networked calls for Ecosystem co-ordinators to learn and share progress.

• Regular Eco news.

Specific

• Cross cutting themed groups. Medicines optimisation and E-Health strategy

China Connected Healthy Alliance

Canada Connected Health Alliance

Key Contacts

Brian O’Connor,

Chair

Brian@echalliance.com

Linkedin account

Damian O’Connor,

Director of Operations

Damian@echalliance.com

Linkedin account

Liz Ashall-Payne

Outreach co-ordinator

Liz@echalliance.com

Linkedin account

Bleddyn Rees

Legal Advisor & Board Director

Bleddyn@echalliance.com

Linkedin account

Julien Venne

Strategic Advisor

Julien@echalliance.com,

Linkedin account

Beatriz Sanz

Events Manager

Beatriz@echalliance.com

Linkedin account

Matt Rigby

Communication Support

Matt@echalliance.com

Linkedin account

Heather Smith

Admin Support

Heather@echalliance.com

Linkedin account

European Connected Health Alliance Bringing Together the future of Health, Social Care & Wellness

www.echalliance.com / info@echalliance.com

Ian Williamson

Chief Officer

Greater Manchester Health and Social Care Devolution

NW Finance Directors

Friday 15 May 2015

NW Finance Directors

Friday 15 May 2015

Ian Williams

Chief Officer

Greater Manchester Health and Social Care Devolution

Chief Officer

Greater Manchester Health and Social Care Devolution

Manchester Connected Health Ecosystem

Health & Social Care Devolution - Introduction

18th June 2015

Warren Heppolette

GM Devolution – the background

Greater Manchester Devolution Agreement settled with Government in November 2014, building on GM Strategy development.

Powers over areas such as transport, planning and housing – and a new elected mayor.

Ambition for £22 billion handed to GM.

MOU Health and Social Care devolution signed February 2015: NHS England plus the 10 GM councils, 12 Clinical Commissioning Groups and NHS and Foundation Trusts

MoU covers acute care, primary care, community services, mental health services, social care and public health.

To take control of estimated budget of £6 billion each year from April 2016.

Vision

To ensure the greatest and fastest possible improvement to the health and wellbeing of the 2.8 million citizens of Greater Manchester

Objectives

• Improve the health and wellbeing of all of the residents of Greater Manchester from early age to older people, recognising that this will only be achieved with a focus on the prevention of ill health and the promotion of wellbeing

• Move from having some of the worst health outcomes to having some of the best

• Close the health inequalities gap within GM and between GM and the rest of the UK faster

Benefits

• Enable us to have a bigger impact, more quickly, on the health, wealth and wellbeing of GM people

• Be more free to respond to what local people want - using their experience and expertise to help change the way we spend the money

• Create more formal collaboration and joint decision making across the region to co-ordinate services to tackle some of the major health, housing, work and other challenges - supporting physical, mental and social wellbeing

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

A growing ageing population

Poorer health & growth in chronic conditions

Instability & fragmentation in the health & care system

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

Greater Manchester local health profile is significantly worse than England Average

SOURCE: 2014 Local Health Profiles, AHPO

Better Mixed Generally worse

General health

Lower than average Higher than average

Deprivation

Comparison to England average

Local Authority

Trafford

Wigan

Tameside

Stockport

Salford

Oldharn

Manchester

Bury

Bolton

Children living in poverty

Life expectancy gap. most and least deprived areas Life expectancy Deprivation

Year 6 children classed as obese

General health

Rochdale 11,900 Lower for men and

women 20.7% • 9.7 years lower for men.

• 7.9 years lower for women

6,500 Higher for women 18.4% • 10.1 years lower for men.

• 6.3 years lower for women

12,000 Lower for men and women

18.9 % • 9.4 years lower for men.

• 8.5 years lower for women

10,300 Lower for men and women

18.6% • 10.9 years lower for men.

• 8.2 years lower for women

8,500 Similar for men and women

17.1 % • 10.8 years lower for men.

• 8.4 years lower for women

12,700 Lower for men and women

21.5 % • 11.5 years lower for men.

• 8.2 years lower for women

13,300 Lower for men and women

19.3% • 11.2 years lower for men

• 9.2 years lower for women

34,630 Lower for men and women

24.7% • 9.6 years lower for men.

• 8.2 years lower for women

6,670 Lower for men and women

19.3 % • 11.5 years lower for men.

• 7.6 years lower for women

13,040 Lower for men and women

20.0 % • 12.1 years lower for men.

• 9.2 years lower for women

Rate of avoidable admissions in all Greater Manchester CCGs is higher than national average

Whilst our disease registers show a high level of disease prevalence we've still only found about half of the preventable disease that exists. In those patients with disease we have only around 40% are treated to evidence based levels leading to our high level of ambulatory care admissions. We can improve treatment processes resulting in real impacts on the rates of disease progression and reductions in preventable admission costs.

18 SOURCE: January 2015 ASC, CCG and Trust information returns

NHS commissioners

NHS Trusts

Adult Social Care

Challenge1

£1,184m

£851m3

£333m

Financial pressures

• Allocations growing at 0.7-2.5% p.a.

• Underlying demand growth: 4.4% in 2014/15, then 5.1% p.a. due to demographic pressures (aging and population growth) and other non-demographic pressures

• Need to invest in new services and improve existing services

• Reductions in price while costs increase (4.0-4.5% p.a. gap between tariff and cost inflation)

• Reduction in hospital activity from integrated care and other commissioner demand management programmes

• Rising costs to meet new clinical service standards (e.g., 24x7 consultant cover)

• Shrinking budgets

• Rising demand from population growth and aging

Health and social care services in Greater Manchester face a £1.1bn financial challenge

1 Commissioner and Trusts challenge as projected for FY 2018/19. Social care challenge as projected to FY 2018/19 2 Plans to resolve the commissioner challenge contribute to provider challenge, thus excluded from total to avoid double counting 3 £237m of the £851 Challenge is directly due to NHS commissioner changes

£237m

Excluded from total to avoid double counting2

This isn’t just about Health

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Worklessness & Low Skills Children & Young People Crime & Offending Health & Social Care Long-term JSA claimants ESA claimants (WRAG) ‘Low pay no pay’ cycles

Working Tax Credit claimants

Low skill levels (vocational or academic)

Insecure employment

NEET (Young People) Compounding factors:

Lone parents with children 0-4

Poor literacy and numeracy

Poor social skills

Low aspirations

Living alone

Child in Need Status (CIN) / known to Children’s Social Care Child not school ready Low school attendance & exclusions Young parents Missing from home Compounding factors:

Repeat involvement with social care

LAC with risk of offending

Poor parenting skills

SEN

Frequent school moves

Single parents

Repeat offenders Family member in prison Anti-social behaviour Youth Offending Domestic Abuse Organised Crime Compounding factors:

Lost accommodation

Dependent on service

Vulnerability to sexual exploitation

Missing from home

Violent crime

Mental Health (including mild to moderate) Alcohol Misuse Drug Misuse Chronic Ill-health (including long-term illness / disability) Compounding factors:

Unhealthy lifestyle

Social isolation

Relationship breakdown / loss or bereavement

Obesity

Repeat self-harm

Living alone

Adult learning difficulties

The roots of poor health are found across society and the public service – we need to do more than just respond at the point of crisis. This requires integration of not just health and care, but contributing wider public services

Whole Public Service Reform Focus

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Troubled Families - families with multiple needs

Early Years - vulnerable children aged 0-5 and their families

Working Well – individuals leaving the Work Programme without a job, also claiming ESA

Justice & Rehabilitation – includes offenders within Integrated Offender Management, with Intensive Community Orders and Women Offenders

Current PSR: focus on testing the principles of a holistic, integrated, sequenced and evidence-based delivery of public services through bespoke programmes aimed at specific cohorts

Complex Dependency - Supporting a broader group of individuals and families with complex needs Sharper focus on employment Supporting those at risk of becoming dependent on public services Implementing PSR principles at greater scale Taking an integrated approach to tackling complex dependency through whole system change in a place

Complex Dependency: build on the evidence to date that a PSR approach works and learning from progress in our reform programmes

The characteristics of our current models

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The main causes of Greater Manchester's high cost/poor outcomes are: • ‘Too late care’ where conditions are either not prevented or detected early

enough, nor treated to evidenced based standards, and patients' needs escalate resulting in preventable hospital based emergency and elective care and for longer than is necessary.

• The perverse incentives and associated self-interested organisational behaviours of Greater Manchester's hospitals, and weak and uncoordinated system management

• A population that is "inactivated". That is too many of our population don't know that better health outcomes are significantly driven by appropriate lifestyle choices, self-care, the health benefits of work and the potential of a prevention driven NHS and Social Care service.

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.”

What does it take to get there?

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• Embed a new city wide “offer” to the population, of ensuring the systematic implementation of primary, secondary and tertiary prevention in all health and social care.

• Use our Public Service Reform opportunities to transform the balance between social and medical support to address properly the social determinants of poor health.

• A new model of general practice, extended in scope and scale to exploit the power of both “big data” using a single electronic record, continuity of care and “people powered health”, to lead a systematic implementation of a prevention service and producing a step change improvement in outcomes.

• Develop a “new contract” with our public detailing their new responsibilities regarding lifestyle choices, self-care and self-management of long term conditions.

• Achieve world class standards of elective and emergency hospital care, with hospital Providers’ collaborating as a system to create a “Centre of Excellence” in Greater Manchester providing “best in world” outcomes, to an “activated” population.

• Effective and objective system management, to ensure that both the new primary care led Provider services and the "Hospital Chain" services deliver continually improving, evidence based standards of care.

• An aligned Academic Health System ensuring we genuinely operate at the margins of science and drive innovation across a ‘Learning Health System’.

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Devo Manc & the GMAHSS

Clive Morris Vice President Research & Development

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Panel Question & Answer

Session

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Networking Lunch & Interactive Market Place

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Workshop: ‘Involving Industry’ Discussion Points

1) How can we ensure that digital and mobile health technologies are used to place patients and patient outcomes at the forefront of this change? 2) What can the Manchester Ecosystem do to help you & your organisation make the most of ‘Devo Manc’?

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Wrap Up & Further Networking