Big Health Day

THE VOLUNTARY SECTOR, THE BIG SOCIETY AND THE GREATER MANCHESTER HEALTH SYSTEM

WARREN HEPPOLETTEJANUARY 20TH 2011

OverviewContext

•The Greater Manchester NHS and the Voluntary & Community Sector

A Challenging Present

•QIPP, the efficiency challenge and deficit reduction

•Liberating the NHS – the NHS White Paper

A Positive Future

•Population health and Greater Manchester’s Assets

•A thriving social market for health

Context

The Greater Manchester NHS and the Voluntary & Community Sector

A population of 2.8m people served by 10 PCTs, 10 Acute Trusts (8FTs), 10 Metropolitan Councils (now operating collectively as a Combined Authority).

Oldham

Bolton

M/cr

ALW

Salford

T&G

Trafford

Stockport

HMR

Bury

PCT

CMFT

Provider

UHSM

Trafford

PENNINE

Salford

WWL

Bolton

Tameside

Stockport

36.05%

46.14%

59.15%

71.98%

70.65%

50.90%

82.67%

77.66%58.26

%

65.30%

28.50%

30.33%

24.85%

12.91%

12.94%

23.87%

8.69%

14.07%

28.51%24.23

%

24.30%

8.72%

11.57%

6.17%

8.54%

17.93%

6.56%

8.35%

6.12%

4.60%

GM Elective Admissions 2009/10

1st

2nd

3rd

Greater Manchester is marked by significant cross boundary acute flows, which provides the rationale for much of the work which has defined collaboration in recent years

The voluntary sector of Greater Manchester is the largest outside London with over 11,000 organisations (6% of the national sector).

• The sector directly employs 67,000 staff (5% of the workforce)

• This does not include around 235,000 unpaid staff and trustees and over a million volunteers

•It contributes at least £1.6 billion to the Greater Manchester economy (much more if the value of unpaid work is included).

•There are over 5,000 registered charities

Greater Manchester’s Voluntary Sector

Greater Manchester has the most developed system of cross-city collaboration in the UK outside London.

This is most expressly illustrated through the recent agreement of Combined Authority status for the 10 Councils. This now provides for accountable political leadership operating at the Greater Manchester level.

Since 2004 the 10 PCTs have pursued formal collaboration, underpinned by a governing Constitution, providing a means of collective decision making for health care commissioning.

Since 1975 the GMCVO has existed to promote a thriving, effective and influential voluntary sector

History of Collaborative working

Since 2004 these arrangements have delivered:

•A major reconfiguration of maternity and children’s services as part of Making it Better building on the biggest public consultation in the NHS’s history.

•Reconfiguration of acute stroke services introducing three hyper acute centres providing service to the whole of the GM population, winning the HSJ Award last year for World Class Commissioning.

•Development of a leading edge Public Health Network overseeing evidence based practice, joint screening programmes, marketing and communications and major prevention programmes on tobacco, alcohol, and healthy weight.

•Establishment of the GM Health Commission representing a formal partnership between the 10 Councils and the NHS under the auspices of the Combined Authority

•Development of the Health Partnership between the PCTs and the GMCVO and the emergence of the UK’s largest VCS procurement consortium

History of Collaborative working

GM Health PartnershipInforming Commissioning

•Support to Psychological Therapies Tender process

•Voluntary sector health website and service directory

Supporting Commissioning

•Hepatitis C Tender

•VCS Health & Wellbeing Consortium

Building Partnerships

•Health & Community Transport

•Representing the sector in GM work

Supporting Localities

•Delivering Racial Equality in Mental Health

•Synergy’ the open forum for local infrastructure staff with a specialism in health and social care

A Challenging Present

Trends in NHS Expenditure (Source:- King's Fund & IFS "How Cold Will It Be?")

0 1 2 3 4 5 6 7

Annual real spend increasesince 1948

20th century average annualincrease

21st century average annualincrease

Lowest annual average byGovernment administration

(1951 - 63)

Highest annual average byGovernment administration

(1997 - 2011)

Budget commitment for realgrowth across public sector

beyond 2010/11

Percentage Real Growth in NHS Expenditure

The financial challenge facing the NHS is without precedent.

This will be a hugely challenging scenario given the continued increases in demand for NHS services over a long period of time. This is a complex multi-factorial issue relating to supply, technological advance, fresh entitlements and the changing population demographics. It is difficult to conceive that this demand will reduce. Furthermore, there are a number of baseline inflationary pressures within the NHS system which, if unaddressed, may require further funding – pay (both pay awards and incremental points), non-pay and estate costs. It is estimated that the “stand-still” inflationary pressures could be of the order of 5% per annum, thus making flat cash, in effect, a real terms reduction in funding

QIPP – The Productivity & Efficiency Challenge

We estimate the size of the gap to be addressed across Greater Manchester is £1.4bn

Financial Picture – Acute Funding

Efficiency Prospectus

NHS White Paper – Liberating the NHS

•GP led commissioning

•Information Revolution

•HealthWatch

•NHS Commissioning Board

•Public Health Transfer

•Health & Well-Being Boards

•Place Based Budgeting

2010/11 2011/12 2013+

10 PCTs

NW SHA

Local GP Consortia

GM NHS Commissioning Board?

Wind Down

Ramp upManaging transition – containment & creativity

PCT Clustering

•Maintain quality, safety, performance and financial balance•Oversight of QIPP Plans•Closedown of the PCTs•Handover to consortia

•Commissioning & contracting for the NHSCB

•Development of initial commissioning support arrangements

Various support arrangements

Creating the New

Commissioning Architecture

10 PCTs

10 Health & Wellbeing Boards

GM Combined Authority

GM H&WB Board

Healthy Lives Healthy People

•Transfer of function

•Ringfenced budgets

•Public Health England

Embedding Leadership for Public Health

10 Local Authorities

The crisis consists precisely in the fact that the old is dying and the

new cannot be born; in this interregnum a great

variety of morbid symptoms appear

A Positive Future

Health & Well Being Boards

•The space to reframe the health partnership between public services, the voluntary sector and communities. The contribution of the voluntary and community sector…

Leadership, Voice & Advocacy

Inform and shape commissioning strategy

Design, deliver and support services

Joint Strategic Needs Assessment – Big Society, Asset Based Approach

•Tackling the deficiency model

•Mapping the strengths and assets of our communities

•Proving the effectiveness of the social market to inform longer term commissioning

•Public Health Responsibility Deal

A Thriving Social Market

•Securing a social finance architecture

•Recognising shifts in funding principles – Payment for Success

•Bridging national policy with local ownership – eg tackling worklessness

•Rethinking procurement – the opportunity of the Consortium

•Meaningful engagement in Community Budgeting

• Aligns directly with GMS approach

• Continued GM influence on government policy

• Potential to develop our four themes: 0-5 Worklessness Offender Management Child Poverty

And other social challenges that need more joining up

Community Budgets

Real joint investment: ‘Table stakes’ Secured commitment to pool/flex local resources

DWPJobcentre

Plus

GM PROBATI

ON

GM POLICE

DWPPrime

contractor(s)

HealthAGMA/

Combined

Authority

Spare seats CVS?

e.g. Local commissi

oning budgets

e.g. Public health

GP budgets

Range of LA place based

resources

e.g. Neighbou

rhood Policing

e.g. Local commissi

oning budgets

e.g. PremisesDiscretionary Funds

Other public servicesPrivate SectorSocial Impact Bond Investors

TrustsLottery

Etc..

e.g. Social Impact Bonds

‘Asks’ of Whitehall DeptsRe: flexibilities, barriers, incentives, targets

Community Budget

DWPJobcentre

Plus

GM PROBATI

ON

GM POLICE

DWPPrime

contractor(s)

HealthAGMA/

Combined

Authority

Spare seats CVS?

Proposed Interventions‘Business case’

‘Gateway’ assessmentPlausibilityCapacityReturns on investment (to who, how, when) Align investor resourcesMainstreaming plan Intervention

deliveryInvestor alignment

Evaluation: outcomes/cost benefits‘Dividend’ distribution (Whitehall, Agency, Community, replenish fund) Roll out decisions Mainstreaming De commissioning

Integrated Commissioni

ng Model

• Your knowledge, connections and ‘reach’ are an asset

• You need to be able to quantify, describe and sell those benefits

• There may be opportunities to make some early running during the significant transition

Concluding messages for the sector