Neil Thornton - Devo Manc - progress to date & future expectations - Wednesday 29 November 2017

February 2015 was a landmark date in the evolution of Greater Manchester’s integration journey, said Neil Thornton, who at the time was Salford City Council’s Chief Financial Officer. “It was when 37 different NHS and local authority organisations came together to sign their agreement with the government.”

The Greater Manchester conurbation’s health and social care budget had an annual spend of £6bn, including as it did ten local authority areas and 2.8m people. “Eye-watering figures,” he told delegates. That £6bn spend was then devolved to Greater Manchester in 2016, following the agreement to take charge of health and social care spending and decision-making.

“So why was Greater Manchester interested in taking on this massive challenge? Primarily, we were interested in delivering better outcomes and felt we could do that if we had the freedom to pursue service delivery in a way that would better meet the needs of our populations. We’d done some calculations and worked out that if we didn’t make a success of integration we’d be looking at a £2bn deficit by 2021.” 

Some of the challenges facing the area included people dying at a younger age than in other parts of the country, and even a ten-year difference in life expectancy between individual wards in Salford, he pointed out. “People in Greater Manchester become ill at a younger age and have to live longer with long-term conditions, and they’re often treated in hospital when their needs could be better met in a social care setting.”

The aim was to deliver the greatest improvement to the health, wealth and wellbeing of Greater Manchester’s 2.8m people through the devolution deal, he stressed. A strategic plan called Taking Charge had then been published, with a focus on wider public service reform. “We didn’t see health and social care as compartmentalised,” he said, and wider issues like air quality, skills and early years development were also integral. “Early intervention and prevention are key,” he stressed.

Performance measures in the strategic plan included an aim to reduce high levels of premature mortality related to respiratory diseases by 580 a year by 2021. “That may not seem like a huge number, but these type of impacts come over a longer time.” In terms of Salford itself, many of Greater Manchester’s wider challenges clearly applied – along with others such as significant population growth and high rates of deprivation – and its aims were not just improving health and social care outcomes and experience, but making better use of limited resources. “If the integration agenda doesn’t work for us it’s a case of where do we go next?” he said. “It’s the only game in town.”

The transformation agenda was being driven by key design principles such as being person-centred, promoting independence and focusing on working with individuals rather than doing things to them, he stressed. Self-care was another important principle, as was co-creating – working together to make sure an offer was right for an individual. Many of the organisations involved already had a long track record of working together successfully, he pointed out, while digital enablement and transforming the workforce were also vital.

Reducing emergency admissions was another key measure – “far too many people are ending up in A&E departments when they don’t need to” – along with extended care and sustainable general practice. Sharing information between health and social care professionals and maximising the importance of self-help would also be key to keeping people out of A&E, he said.

From a commissioning point of view, meanwhile, the activities of the clinical commissioning groups and local authorities were being brought together to improve coordination, and a pooled health and local authority budget had also been created. “We wanted to send a signal that we were prepared to put our money where our mouth was,” he said.

All of this meant a range of requirements such as improved governance and a due diligence process, and Salford now had an integrated care organisation and had also benefited from NHS ‘vanguard’ status. “Things are moving forward on a sound basis,” he told delegates. “We’re making progress in some areas, while others are proving harder to crack. We’ve invested a lot of money and time in getting a range of professionals to work together in a consistent way, instead of in silos, and we’re also starting to see overall reductions in A&E attendance. We did manage to balance our budgets, which is fantastic. We’re making real inroads in terms of improving outcomes for local people.”

Three key pieces of advice for other areas planning on going in the same direction were to be clear about exactly what they were trying to achieve – strategy documents were key to this – recognising that structural change was essential, and accepting that things were not going to change overnight. “It may well take longer than the usual one to two year horizon to see the benefits. You need to stick with it.”