Public Service Reform and the Public’s Health

1. Public Service Reform and the Public’s Health

2. PSR Strategic Overview • Ambition is for sustainable economic growth, where all residents contribute to and benefit from sustained prosperity. This is set out in the GMS and our Growth and Reform Plan. • Generating growth and jobs will not be sufficient to close the gap between tax and public spending. • Reform public services to connect our people and neighbourhoods to growth.

3. Reform has to become a key mainstream element of how districts and partners will meet the financial challenges of 2015/16 and beyond. • 2014/15 – two big ticket proposals to significantly scale up reform: • Complex dependency – broader and deeper than Troubled Families • Health and social care integration – investing in integrated care at scale

4. Ambition to be Financially Self-Sufficient 22bn 17bn • GM spends around £5bn more than our total tax contribution • Total tax take estimated at £17bn. Significant investment in growth. GM economy more resilient than most • Need to sustainably reduce £22bn public spending • Total spend has not changed in real terms, despite the cuts • Proportions have changed – more on welfare benefits: costs of failure • Work and skills is the key issue for both growth and reform; productivity, dependency and public spending £22.9 bn £22.5 bn

5. Reform and Growth • GM vision to pioneer a new model for sustainable economic growth, based around a more connected, talented, and greener city region where all our residents are able to contribute to and benefit from sustained prosperity. • GM PSR Programme is central to the delivery of this vision. Increasing independence and enabling people and their families to take advantage of economic growth across the wider city region. • PSR is how GM will reduce demand and dependency on public services by putting in place evidence based activity that reduces dependency, enables greater productivity and economic growth. PSR principles • Interventions chosen on strength of evidence base • Integrated and sequenced – bespoke packages of support – right time and order • Family based approach not just focusing on an individual • New investment models – partners investing across boundaries

6. Reform Timescales October 2013 • Develop best examples of Investable Propositions • Submit GM Growth and Reform Plan for deal with Government, and ESF£ Autumn 2013 – March 2014 • Commit to testing PSR at greater scale over next 18 months to generate strongest possible evidence End March 2014 • Submit Health and Social Care pooled budget plans • ESF round 2014-2020 starts October 2013 March 2014 2014/15 – March 2015 • Testing PSR at greater scale • Obtain strong evaluation evidence of actuals, to replace modelled assumptions • Second version Investable Propositions that convince partners to invest at scale, and Government to do a GM deal 2015/16 to 2020 • Investment agreements operational for all PSR themes • Fully implement PSR across GM • Aim to have GM deal on growth and reform with the next Government over a full spending period April 2014 April 2015 2020

7. Physical Activity and Public Service Reform • Need to target public health interventions and bend the focus of mainstream services to stem the flow of demand. • There is now better understanding that physical inactivity is a risk factor for ill health - and future dependency on public services. • Some recognition that all agencies need to take action to reduce inactivity to reduce future demand on public services. • However, physical activity is not regularly included in mainstream activities and many agencies are not clear what cost benefits are associated with increased physical activity.

8. Evidence base is available – and well developed in some areas – but not routinely applied by services. • Return on investment tool has been developed but it measures benefits for health services (NHS) not all other agencies. • More work to ensure that physical activity is reframed – as an evidence based intervention to reduce demand on public services…

9. Cycling: Societal Benefits • Older people (50+) who engage in regular physical activity reduce their risk of dementia by 40%. (Dementia related services cost local government and the NHS over £19 billion a year) • Mental health – condition management is better and recovery for longer for patients that undertake regular exercise (cycling is specifically mentioned). • The LSE Report - The British Cycling Economy: • Gross cycling product (potential growth for Greater Manchester) of £230 per cyclist. • Frequent and Regular cyclists could save the economy £2 billion across ten years in reduced absenteeism • Latent demand for cycling could amount to around £516 million of untapped economic potential for UK

10. Cycling and Public Sector Reform • Need to raise awareness of what the future costs to public service agencies will be for a population that do not exercise regularly. • Translate the physical activity language to one that is relevant for adult social care, children’s services etc. • Be clear about how cycling can be built into other community activities or services.

11. Think about how the conversation moves on from 20 mph schemes (important but not everything) – to exercise becoming part of case management with complex individuals. • Help agencies understand that investment in cycling is more than capital schemes. • Working with community asset building programmes to develop community infrastructure to help people get on their bikes, keep their bikes working and stay safe.