Big Health Day
THE VOLUNTARY SECTOR, THE BIG SOCIETY AND
THE GREATER MANCHESTER HEALTH SYSTEM
WARREN HEPPOLETTE
JANUARY 20TH 2011
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
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).
Bury
Bolton
14.07
%
Bolton
WWL
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
4.60%
24.23
%
70.65
%
PENNINE
6.17%
65.30
%
HMR
77.66
%
58.26
%
6.12%
28.51
%
82.67
%
Oldham
8.69%
Salford
71.98
%
M/cr
Salford
12.94
%
23.87
%
8.54%
Tameside
50.90
%
6.56%
8.35%
Trafford
1st
12.91
%
T&G
46.14
%
30.33
%
CMFT
36.05
%
2nd
8.72%
3rd
Trafford
Provider
24.30
%
Stockport
17.93
%
24.85
%
28.50
%
UHSM
11.57
%
Stockport
59.15
%
PCT
GM Elective Admissions 2009/10
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
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
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
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
A Challenging Present
Trends in NHS Expenditure (Source:- King's Fund & IFS "How Cold Will It Be?")
Budget commitment for real
growth across public sector
beyond 2010/11
Highest annual average by
Government administration
(1997 - 2011)
Lowest annual average by
Government administration
(1951 - 63)
21st century average annual
increase
20th century average annual
increase
Annual real spend increase
since 1948
0
1
2
3
4
Percentage Real Growth in NHS Expenditure
5
6
7
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
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
Creating the
New
Commissioning
Architecture
2011/12
2013+
Local GP Consortia
10 Local Authorities
PCT Clustering
10 PCTs
NW SHA
•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
10 Health & Wellbeing
Boards
Various support arrangements
GM Combined Authority
GM H&WB Board
Embedding
Leadership for
Public Health
Healthy Lives Healthy People
10 PCTs
•Transfer of function
GM NHS Commissioning
Board?
•Ringfenced budgets
•Public Health England
Managing transition – containment & creativity
Wind Down
Ramp up
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
Community Budgets
• 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 Budget
Real joint investment: ‘Table stakes’
Secured commitment to pool/flex local resources
Spare
seats
DWP
Jobcentre
Plus
GM
PROBATIO
N
GM
POLICE
e.g.
Premises
Discretiona
ry Funds
e.g. Local
commissio
ning
budgets
e.g.
Neighbour
hood
Policing
e.g. Social
Impact
Bonds
Other public
services
Private Sector
Social Impact Bond
Investors
‘Asks’ of
Whitehall Depts
Re: flexibilities,
barriers, incentives,
targets
Trusts
Lottery
Etc..
e.g. Local
commissio
ning
budgets
e.g. Public
health
GP
budgets
DWP
Prime
contractor(
s)
Health
Range of
LA place
based
resources
AGMA/
Combined
Authority
CVS?
DWP
Jobcentre
Plus
Spare
seats
GM
PROBATIO
N
Proposed
Interventions
‘Business case’
Evaluation: outcomes/cost benefits
‘Dividend’ distribution (Whitehall,
Agency, Community, replenish fund)
Roll out decisions
Mainstreaming
De commissioning
Intervention
delivery
Investor alignment
Integrated
Commissioning
Model
DWP
Prime
contractor(
s)
Health
GM
POLICE
‘Gateway’ assessment
Plausibility
Capacity
Returns on investment (to
who, how, when)
Align investor resources
Mainstreaming plan
AGMA/
Combined
Authority
CVS?
Concluding messages for the sector
• 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