1. 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

2. 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

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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.

12. 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.

13. Questions & Discussion
Slide 13