Director of Public Health Manchester City Council Devo-Manc Manchester LPC David Regan Director of Public Health Manchester City Council 13 May 2015 David Regan

The devolution of health and social care has made national headlines; illuminating both the opportunity but also the expectation Greater Manchester £6bn NHS budget devolution begins in April 27 February 2015 Greater Manchester will control a combined NHS and social care budget of £6bn Greater Manchester will begin taking control of its health budget from April after a devolution agreement was signed by the Chancellor George Osborne.”. It's a historic day for Manchester, but not a 'town hall takeover' 27 February, 2015 | By Crispin Dowler NHS insiders in Greater Manchester have been pleasantly amazed by the speed at which negotiations progressed leading up to today’s historic agreement to devolve and integrate £6bn of health and social care spending for the conurbation. Revealed: Details of £6bn Manchester health devolution plan 25 February, 2015 | By James Illman Radical plans for Greater Manchester to take control of £6bn of health and social care spending will be overseen by a new statutory body from April 2016, according to draft plans obtained by HSJ. Health devolution for Greater Manchester 25 February 2015 Greater Manchester is to become the first region in England to get full control of health spending. 2

What does Devolution offer? The overriding purpose of the initiative represented in this Memorandum of Understanding is to ensure the greatest and fastest possible improvement to the health and wellbeing of the 2.8 million citizens of Greater Manchester (GM). This requires a more integrated approach to the use of the existing health and care resources - around £6bn in 2015/16 - as well as transformational changes in the way in which services are delivered across Greater Manchester. ……A focus on people and place 3

Objectives Improving the health and well being of GM residents from early age to elderly - recognising will only be achieved with a focus on prevention of ill health and promotion of well being Moving from having some of the worst health outcomes to having some of the best and closing the health inequalities gap within GM and between GM and the rest of the UK faster By Integrating care for a more holistic, co-ordinated approach Putting experience of patient, carer and families at the centre of how services are organised and delivered. Making best use of existing budgets, including to improve performance around reducing pressure on A&E and avoiding hospital admissions, where appropriate.

GM Governance Joint Commissioning Board Provider Forum Greater Manchester Strategic Health & Social Care Partnership Board Chair, 10 LAs, 12 CCGs, Providers, NHS England, Regulators, Healthwatch, GMCVO Joint Commissioning Board 12 CCGs, LA, NHS England Provider Forum Acute, Community, Mental Health, Ambulance, Primary Care, Social Care, Public Health 5

Devolution is the mechanism, not the master A growing ageing population Poorer health & growth in chronic conditions Instability & fragmentation in the health & care system What is the problem we are trying to solve…? 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 ….devolution can be the trigger for greater and necessary positive reform 6

What does radical reform look like? 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.” 7

Strategic Initiatives Clinical & Financial Sustainability Plan (including CSR submissions) Early Implementation Priorities Mental Health Strategy Research, Innovation & Economic Growth Strategy Capital & Estates Workforce Transformation Support Services Strategy (overall efficiency and joint working developments) Establishing the Leadership, Governance & Accountability Programme Board & Infrastructure GM Health & Care Strategic Partnership Board GM Joint Commissioning Board GM Provider Forum Establishing the Relationship with Regulators* Enablers OD & Leadership Development Communications, Patient/Public Engagement Information, data sharing and digital integration Devolving & Integrating Responsibilities and Resource Resources & Finance Primary Care Specialised Services Prevention & Public Health Workforce Training and Development & Support to Challenged Trusts 8

Early Implementation Priorities 7 day access to general practice Workforce policy alignment Public health campaign Academic Health Science System Healthier Together decision Dementia pilot Mental health and work 9

Timeline to Devolution Spring 2015 Summer 2015 Autumn 2015 Winter 2015 Spring 2016 Summer 2016 Autumn 2016 Winter 2016 Spring 2017 DECEMBER: Production of the final agreed GM Strategic Sustainability Plan and individual Locality Plans ready for the start of the 2016/17 financial year DECEMBER: In preparation for devolution, GM and NHSE will have approved the details on the funds to be devolved and supporting governance, and local authorities and CCGs will have formally agreed the integrated health and social care arrangements. APRIL: Process for establishment Of Shadow Governance Arrangements Agreed and initiated MAY-DECEMBER: Announcement of Early implementation Priorities APRIL: Full devolution of agreed budgets, with the preferred governance arrangements and underpinning GM and locality S75 agreements in place. AUGUST: Production of an Outline Plan to support the CSR process which will Include a specific investment fund proposal to further support primary and community care and will be the first stage of the development of the full Strategic Plan.

What wont change due to devolution? The NHS will be responsible for keeping people safe and delivering the NHS Mandate and Constitution to all residents Formal consultation will continue to be a legal duty when the NHS considers changes to services and clinicians will continue to be at the forefront of decisions about health. Statutory bodies such as Healthwatch will continue to be highly involved in decision making. There will be no new layer of government and resources will not be taken away from the front line to support this CCGs and Councils will keep their existing accountabilities, legal obligations and funding There will be no requirements for NHS reorganisation.

What will change due to devolution? Greater Manchester will be fully involved in decisions which affect GM being considered at a national or regional level this year. From April 2016 GM will take those decisions locally. GM will take local control to work together in new ways to tackle some of the major health, housing, work and other challenges we face in our region. GM will move quickly – we are already planning major projects this year where we believe early progress can be made through the use of the new devolved arrangements. These projects will enable us to test implementation at scale on behalf of NHS England, and to quantify their impact for the eventual sustainability plan.

Questions & Discussion Slide 13