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Big Health Day

Big Health Day. THE VOLUNTARY SECTOR, THE BIG SOCIETY AND THE GREATER MANCHESTER HEALTH SYSTEM WARREN HEPPOLETTE JANUARY 20 TH 2011. Overview. Context The Greater Manchester NHS and the Voluntary & Community Sector. A Challenging Present

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Big Health Day

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  1. Big Health Day THE VOLUNTARY SECTOR, THE BIG SOCIETY AND THE GREATER MANCHESTER HEALTH SYSTEM WARREN HEPPOLETTE JANUARY 20TH 2011

  2. Overview • Context • 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

  3. Context The Greater Manchester NHS and the Voluntary & Community Sector

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

  5. Bury Bolton 77.66% HMR 58.26% 14.07% Bolton WWL 70.65% 6.17% PENNINE 65.30% 4.60% 6.12% 28.51% 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 ALW 82.67% 24.23% Oldham 8.69% 12.94% Salford 23.87% 8.54% 71.98% M/cr Tameside Salford 50.90% 6.56% 46.14% 8.35% T&G Trafford 12.91% 30.33% 1st 2nd 3rd CMFT 36.05% 8.72% 24.30% Trafford Stockport 17.93% 24.85% Provider 28.50% 59.15% 11.57% Stockport UHSM PCT GM Elective Admissions 2009/10

  6. Greater Manchester’s Voluntary Sector • 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

  7. History of Collaborative working • 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

  8. 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

  9. GM Health Partnership • Informing 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

  10. A Challenging Present

  11. QIPP – The Productivity & Efficiency Challenge 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 We estimate the size of the gap to be addressed across Greater Manchester is £1.4bn

  12. Financial Picture – Acute Funding

  13. Efficiency Prospectus

  14. 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

  15. 2010/11 2011/12 2013+ Local GP Consortia Creating the New Commissioning Architecture • PCT Clustering 10 Local Authorities 10 PCTs NW SHA • Commissioning & contracting for the NHSCB • Development of initial commissioning support arrangements • Maintain quality, safety, performance and financial balance • Oversight of QIPP Plans • Closedown of the PCTs • Handover to consortia 10 Health & Wellbeing Boards Various support arrangements GM Combined Authority GM H&WB Board Embedding Leadership for Public Health • Healthy Lives Healthy People GM NHS Commissioning Board? 10 PCTs • Transfer of function • Ringfenced budgets • Public Health England Ramp up Managing transition – containment & creativity Wind Down

  16. 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

  17. A Positive Future

  18. 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

  19. 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

  20. 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

  21. 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

  22. Real joint investment: ‘Table stakes’ Secured commitment to pool/flex local resources Community Budget ‘Asks’ of Whitehall Depts Re: flexibilities, barriers, incentives, targets DWP Jobcentre Plus GM PROBATION GM POLICE e.g. Neighbourhood Policing e.g. Premises Discretionary Funds e.g. Local commissioning budgets Spare seats e.g. Social Impact Bonds CVS? Trusts Lottery Etc.. e.g. Local commissioning budgets e.g. Public health GP budgets Range of LA place based resources Other public services Private Sector Social Impact Bond Investors DWP Prime contractor(s) Health AGMA/ Combined Authority

  23. DWP Jobcentre Plus GM PROBATION GM POLICE Proposed Interventions ‘Business case’ Evaluation: outcomes/cost benefits ‘Dividend’ distribution (Whitehall, Agency, Community, replenish fund) Roll out decisions Mainstreaming De commissioning ‘Gateway’ assessment Plausibility Capacity Returns on investment (to who, how, when) Align investor resources Mainstreaming plan Spare seats CVS? Intervention delivery Investor alignment Integrated Commissioning Model DWP Prime contractor(s) Health AGMA/ Combined Authority

  24. 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

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