Integrating health and social care and further emphasising prevention and early help is a huge challenge – but one with enormous potential rewards.
The most important reward is improving people’s physical and mental health and opportunities to thrive. But the happy corollary is reducing demand on services, especially the costliest.
In common with areas across the country, Manchester is under intense financial pressure. Health and care costs are among the largest strains. For the city, our estimated deficit by 2020-2021 if we don’t reform is £147m.
Putting aside the debate about funding levels for care – partnership and the pooling of resources at a local level must be the way to make a positive difference.
That’s why we are undergoing a transformational project, aimed at radically changing both structures and how everyone in health and social care works together – and with the city’s people.
This is underpinned by our population health plan, an overall strategy for a healthier city. Our priorities are around the first 1,000 days of a child’s life, strengthening the positive impact of health on work; supporting people and communities to be socially connected and make positive changes; creating an age-friendly city; and acting on preventable early deaths.
This Manchester population health plan echoes a Greater Manchester-wide one, which recognises that a healthy and happy population is fundamental to economic growth.
We have a clear sense of what can be better achieved at a Greater Manchester level and what is best done more locally. Elected members have clear roles at both local and wider strategic levels.
Greater Manchester’s 2015 devolution deal with government was key to us starting to make the changes needed. This was supported by a transformation fund, £450m for Greater Manchester, of which Manchester has so far received £70m, which is helping kickstart new models of care.
Manchester’s locality plan set out some bold structural changes.
Our city is in the process of moving from three big hospital trusts to a single hospital service for the city. Manchester Foundation Trust now covers central and south Manchester, with plans in train to transfer north Manchester too.
As of April last year we have moved from having three clinical commissioning groups (CCGs) to a single commissioning function – Manchester Health and Care Commissioning – which includes Manchester City Council commissioning as well as the former CCGs, with a pooled budget of £1.1
The final pillar of this fundamental change is the new Manchester Local Care Organisation integrating the delivery of social care, primary care, community health and mental health services in 12 neighbourhoods, and connected to wider council and voluntary sector services.
These changes are essential to join all care around the individual, so they get a single package. In this new world they will no longer have to tell their story a dozen times or be assessed 15. Instead we look at providing a circle of support which recognises how important work, leisure and other opportunities are to their overall health.
The next phase is driving delivery to ensure outcomes for Manchester people are improved.
New behaviours are also required to ensure everyone involved in the system works well together and systems aren’t allowed to get in the way of people’s needs. What we call the Our Manchester approach is about starting from people’s strengths, listening to them and being willing to do things differently.
This is a long-term challenge and requires genuine joint leadership across the system and a shared understanding of risk and gain, with real savings generated and reinvested to sustain new models of care.
Our three big priority areas for the year are putting in place 12 integrated neighbourhood teams combining primary care, social care, mental health and community and voluntary services; Manchester Community Response, an integrated approach to helping people in and out of hospital and acute care; and high impact primary care.
An early example of the value of focussing on supporting people leaving hospital is the work to tackle high demand for beds at Manchester Royal Infirmary this summer. Our team helped 16 ‘stranded’ patients with complex issues, who had a combined 1,600 bed days between them, be safely discharged from hospital.
On the primary care front, GPs are acting as lead workers for around 12,000 people – about 2% of our population – who place the greatest demand on health and care services. We’ve already seen some good examples of big reductions in repeat visits to A&E, ambulance call outs and out-of-hours demands on police services while helping people access improved services.
We have made a good start in Manchester and I am incredibly proud that we are collectively tackling this head on rather than shirking it. Confronting such a challenge takes time but we need to stick with the radical transformation which is underway and the genuine partnerships with health colleagues, the voluntary sector and communities themselves which have been built up.
Then the sort of improvements we are beginning to see – win-wins where residents and services both benefit – will spread across the city.
Joanne Roney, chief executive, Manchester City Council