Ian Williamson Chief Officer Greater Manchester Health and Social Care Devolution

1. Place Based Agreement for Public Health in Greater Manchester Abdul Razzaq – Director of Public Health TraffordVice Chair, GM Directors of Public Health GroupAssociation of Directors of Public Health15th June 2015 NW Finance DirectorsFriday 15 May 2015NW Finance DirectorsFriday 15 May 2015 Ian Williamson Chief Officer Greater Manchester Health and Social Care Devolution

2. Greater Manchester Strategy: Stronger Together Updated and re-positioned 2013 reflects the economic greater focus on public service reform agenda stronger on delivery and implementation Originally developed in 2009 • informed by the Manchester Independent Economic Review’s (MIER) evidence base • aligned all partners behind priorities • strategic framework for policy and decision making • pitch to Government – GM as having greatest potential for economic growth outside of London and South East

3. Ambition - GM as a net contributor to the national economy GM’s economy currently generates £17bn in taxes BUT requires £22 billion in public spending Reductions in local public spending in investment and growth But increasing spend for national sources welfare and health

4. 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.

5. Vision for Health and Care – NHSE/GM MOU “To ensure the greatest and fastest possible improvement to the health and wellbeing of the 2.8 million citizens of Greater Manchester” NB – this is the vision that underpins the 5 year strategic plan for clinical and financial sustainability in GM

6. Objectives • To improve the health and wellbeing of all of the residents of Greater Manchester (GM) from early age to the elderly, recognising that this will only be achieved with a focus on prevention of ill health and the promotion of wellbeing. We want to move from having some of the worst health outcomes to having some of the best; • To close the health inequalities gap within GM and between GM and the rest of the UK faster; • To deliver effective integrated health and social care across GM; • To continue to redress the balance of care to move it closer to home where possible; • To strengthen the focus on wellbeing, including greater focus on prevention and public health; • To contribute to growth and to connect people to growth, e.g. supporting employment and early years services; and • To forge a partnership between the NHS, social care, universities and science and knowledge industries for the benefit of the population.

7. Programme Approach Health & Social Care Devolution Programme DMT contact: Alex Heritage Strategic Plan (Clinical & Financial Sustainability) DMT contact: Liz Treacy Establishing Leadership, Governance & Accountability DMT contact: Sarah Senior Devolving Responsibilities and Resources DMT contact: Warren Heppolette Partnerships, Engagement and Communications DMT contact: Leila Williams Early Implementation Priorities Programme Area Resources and Finance 7 Day Access to Primary Care The GM plan contains the following chapters: • Strategic Plan • Locality and Sector Plans • GM Transformation Proposals and • Financial Plan and Enablers It is recognised that a large proportion of the other programme areas will feed in to the Strategic Plan at the appropriate point, highlighted to the right Governance Patient, Carer & Public Engagement Primary Care Transfer Decision Making Mechanisms Public Health Place based agreement Communications and Stakeholder Engagement Specialised Services Transfer Legislative and Accountability Framework Change Movement Academic Health Science System Prevention, Self Care and Public Health (Single Unified Public Health System) OD and Leadership Development Healthier Together Decision Workstreams Enablers (Workforce Training, Development and transformation, Capital and Estates) Dementia Pilot Mental Health and Work Support Services Strategy Key chapters of the strategic plan Workforce Policy Alignment Support to Challenged Trusts Additional work that feeds the strategic plan CAMHS 7 Other areas of work

8. Public Health Leadership – Opportunity and Challenge • An opportunity – the greatest commitment of whole public system leadership to the priorisation of population health as at the centre of growth and reform ambition • But - Public Health Leadership in the place is diffuse and fragmented • GM Directors of Public Health Group • GM Public Health Network • Public Health England • NHS England • Residual CCG expertise/capacity • other • And - A perception in some quarters (fair or unfair) that Public Health Leadership is not aligned to the GM objectives of growth and reform • Public Health Intervention to complex dependency cohort re worklessness • A commentator on the failure of others to “do the right thing”.

9. Place Based Agreement • Due to be signed early July by GM Combined Authority, Public Health England, and NHS England, and supported by the Association of GM CCGs, and the GM NHS Provider Forum • “This agreement therefore creates a framework by which Public Health England, Greater Manchester Authorities, NHS England, supported by the Association of GM CCGs and GM NHS Providers, will create a single unified Public Health Leadership system capable of supporting the required transformational and sustainable shift in the health and well-being of the population if GM is to improve the lives of residents, capitalize on its economic potential and deliver a sustainable health and care system.”

10. Unified Public Health Leadership System requires (1) • More effective organisation of currently devoled PH leadership • Better deployment of expertise across Districts • Joint Commissioning Arrangements • Pooled Budget • More effective and joined up Health protection working across GM • Healthcare public health capacity • GM Public Health Strategy • Clearer mandate and reporting of lead DPH role • Strengthened engagement with GM DASS and DCS group • Be at the table – economic development, transport, housing, GM Spatial Planning • Retention of public health capacity in each district.

11. Unified Public Health Leadership System requires (2) • Reorientation of PHE Capacity to the Place • Recognition of GM priorities and objectives • Alignment of capacity and expertise • No decision about GM without GM • Commitment to unified leadership • Explicit commitment to GM Academic Health Science Network • Shared approach to evidence base and evaluation • Strengthened contribution to local health protection working (but retain organisational critical mass)

12. Unified Public Health Leadership System requires (3) • Reorientation of NHSE to the Place • Work with the GM system to integrate S7a commissioning resources and capacity into emerging GM integrated pathways such as for Early years ; cancer services; diabetes prevention and management; offender health. • Develop ambitious plans to address the variation in uptake of the national screening and immunisation programmes within GM, • Work with PHE to align PH staff resources currently supporting the commissioning of S7a services with the new commissioning models • Work with partners to take an upstream approach to the public sector reform agenda

13. PBA Describes 4 Key priorities • Nurturing a Social Movement for change - Enabling people to make their own informed life-style choices and creating new platforms for full engagement • Starting Well – Early Years – the scaled implementation of the GM early years model to improve school readiness and addressing long term determinants of public service demand • Living Well - Work and Health - aligning public health intervention to wider public service reform tackling complex dependency and supporting residents to be in sustainable and good quality work, • Aging Well – Setting up a Greater Manchester centre of excellence on Ageing to support age-friendly communities and environments, and scaling work on dementia friendly communities, supporting those with dementia to remain connected to their communities and in control of their lives for as long as possible

14. A running start to get some early wins… • Support the implementation of the GM health and care devolution early implementation priority of mental health and worklessness • Reducing the impact of hypertension • Increasing the impact of Health Checks • Accelerating the learning from the implementation of the preventing diabetes framework • Developing enhanced outbreak management and response arrangements • Alcohol Licensing - Securing (as part of the wider devolution agreement) a 5th licensing condition associated with harm to health • Accelerating the learning across Greater Manchester from the Well North pilot sites, aligned to the learning from the GM public service reform programme of complex dependency

15. GM is now “Officially the most exciting place in the UK!” • The Guardian – 25th Feb 2015