Warren Heppolette, Strategic Director – Health & Social Care Reform Greater Manchester, looks at opportunities that exist beyond core health and care services to benefit health.
The recent historic health devolution agreement signed in Greater Manchester puts local people in the driving seat for deciding on health and care services. It is also the biggest act of devolution in England’s NHS since 1948 – and ensures that decisions affecting Greater Manchester are taken in Greater Manchester by our local elected representatives and GP leaders.
The trailblazing move saw NHS England, 12 NHS Clinical Commissioning Groups, 15 NHS providers and 10 local authorities agree a framework for health and social care – with plans for joint decision making on integrated care to support physical, mental and social wellbeing.
Devolution is about ensuring that a deep understanding and knowledge of people and place drives public service planning and delivery. Devolution is about having the responsibilities and powers to shape the future of public services with our own communities.
This keeps decision making closer to the ground, it makes political and public service leaders more accountable and allows integrated investment to reform public services. This will then improve the health of our population and generate growth.
Devolution therefore is a means to an end - to give us more influence and control over the factors we all know will improve the health, wellbeing and prosperity of our population.
Poor health is too prevalent in Greater Manchester and so are other socio-economic factors like long-term unemployment – which is often linked to mental and physical illness. Our health and care services are also under significant pressure with demand rising across all parts of that system. We have therefore, a leadership choice on how we meet that rising demand - we can simply build more hospitals or consider whether we can actually affect the nature and scale of that demand to prevent health crises developing and to delay or prevent the onset of disease.
Currently too many of our public services are based on a crisis response – instead of looking at and acting on early signs of vulnerability. The balance of our attention, effort and resource needs to change. It needs to prioritise proactive, pre-emptive care and support.
This change has to recognise that medical interventions, employment support, education and training to improve skills cannot continue to be directed from multiple different sources in a disjointed fashion. It must be properly sequenced and understood as a blend which works for one person at a time.
Devolution starts to make that blend possible. It re-positions organisational priorities towards place and people to allow us to confirm and act on shared objectives. It means a focus not only on integrating health and social care, but integrating all public services in the interests of our residents.
We are already seeing how better links between the police and mental health services can help people in crisis. We are already seeing how better connections between employment services and health care can help people find and keep good work. And we are already seeing where joined up working between the fire service and ambulance service can provide good early help alongside preventative support in people’s homes.
This means that we need to take full advantage of the opportunities afforded by the wider public sector, and most significantly through the assets, strengths and ambitions or the residents of Greater Manchester. This is much, much more than integrating health and social care, as important as that is. The opportunities here, if we look beyond core health and care services, to all of those assets which contribute to health gain, are enormous:
- the Fire Service undertakes 60,000 Safe and Well checks in the homes of the most vulnerable people in GM every year - this is one of our most significant public health interventions;
- we aim to get 50,000 people back into work – this will reduce drug and alcohol dependency for those resident by more than half and reduce mental illness by 75%;
- 27 social housing providers in GM have huge potential to support the management of long term conditions in the community, support hospital discharge and community reablement;
- 700 community pharmacies working within integrated neighbourhood teams to support safer, more proactive, personalised care and health improvement to avoid repeat GP appointments and A&E attendances;
- 14,000 community organisations and 334,000 volunteers facilitating, supporting and co-ordinating health improving activity can reach communities in ways the statutory sector cannot to affect health outcomes.
Our response to this devolution opportunity will make public service partnership routine across all parts of Greater Manchester. We plan now to pursue a holistic transformation of health care and wider public services to improve both the health and life opportunities of our residents.