Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event. Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being. More information is available online: www.expo.nhs.uk

1. Delivering clinical and financial
sustainability across a £6 billion health
economy
Donna Hall, Chief Executive, Wigan Council
Dr Ranjit Gill, Chief Clinical Officer, Stockport CCG

2. Scale of the Challenge

3. 8 July Budget
• Health and social care leaders from across Greater Manchester are now coming together as part of
the transition to their control of their £6bn health and social care budget.
• Together they are making progress on work to extend seven day access to primary care, radically
upgrade prevention and public health, help those with mental ill health into work and make Greater
Manchester’s Academic Health Science System a national leader.
• By the end of this year they will have a Greater Manchester StrategicPlan in place to show how
they will deliver a clinically and financially sustainable set of health and social care services for the
people of Greater Manchester. The production of the Strategic Sustainability Plan will be aligned
with the Comprehensive Spending Review (CSR) process that applies to NHS, Public Health
and local authority social care funding.

4. Scale of the Challenge

5. Progress to date
Through devolutionsignificant progresshas already been made in the following areas:
• A commitment that by the end of 2015 everyone living in Greater Manchester (GM) will have same
day access to primary care, supported by diagnostic tests for seven days a week. This is
alongside a commitment to transform and integrate how services are delivered as part of non
hospital care. There are agreed quality standards that will apply across GM.
• A decision on the reconfiguration of Acute Services through Healthier Together. On 15 July there
will be a decision on which hospitals will work in partnership as single services and which fourth
hospital will specialise in general surgery and emergency medicine as part of that single service.
The alliance to achieve this has been built by being able to tell the whole story of the
reconfigurationof health and social care services in each locality and not just focussing on the
current role of hospitals thus giving a strong platform for the delivery of future change.

6. Progress to date
• Delivery of a Memorandumof Understanding (MoU) for Public Health – On July 10, a MoU was
signed between GM, Public Health England (PHE) and NHS England (NHSE) supported by key
partners including NHS commissioners and providers in GM and Blue Light Services. The
agreement creates a framework by which partners will create a single unified public health
leadership systemcapable of contributing to a transformational and sustainable shift in the health
and well-being of the population.
• Delivering the only accelerated health science centre outside of London and the South East. There
will be a new Academic Health Science System (AHSS) partnership with its own governance and a
prospectus setting out changes that will be delivered. Work continues to establish an over-arching
Board to facilitate alignment of the work of partner organisationsto respond to health and well-
being needs of the conurbation and capitalising on research and innovation assets across Greater
Manchester. Thiswill deliver a smooth and integrated pathway from discovery science and
innovation, through experimental medicine and clinical research to reliable and consistent
adoption and diffusion.
• Early priorities include integrating and scaling up health informatics to cover the entire
GM population, enhance personalised/stratified medicine capabilitiesand develop
clinical trials capacity and effectiveness.

7. The Vision for Public Health
The focus will be on making the case for the ‘economics of prevention’demonstrating that the link
between public health, employment and early intervention outcomes.
There are five major transformational programmes of work:
• Public health, reform and growth– Making the most powerful case yet for the ‘economics of
prevention’demonstrating the link between public health, employment and early intervention outcomes
and setting this out in a joint submission to the SpendingReview
• Nurturing a Social Movementfor change - Enabling people to make their own informed life-style
choices and creating new platforms for full engagement of GM residents
• Starting Well – Early Years – the scaled implementation of the GM early years model to
improve school readiness and addressing long term determinants of public servicedemand

8. • Living Well - Work and Health - aligning public health intervention to wider public
service reform tackling complex dependency and supporting residents to be in
sustainable and good quality work
• Ageing Well - Ageing Well – Setting up a Greater Manchester Ageing Hub to support
age-friendly communities and environments, and scaling work on dementia friendly
communities, supporting those with dementia to remain connected to their
communities and in control of their lives for as long as possible

9. The Vision for Public Health
Early implementation priorities:
• Supporting the implementation of the GM health and social care devolution early
implementation priority of mental health and worklessness.
• Reducing the impact of hypertension.
• Increasing the impact of Health Checks through more consistent implementation
across GM.
• Developing enhanced outbreak management and response arrangements.
• Alcohol Licensing - Securing (as part of the wider devolution agreement)
a 5th licensing condition associated with harm to health.

10. The Vision for Public Health
• Accelerating the learning across Greater Manchester fromthe Well North pilot sites, aligned
to the learning from the GM public service reform programme of complex dependency.
• Working with the GM Fire and Rescue Service to convert the GMFRS Home Safety Check
into a 'Safe and Well'Assessment tool, and extending the work of the GM Community Risk
Intervention Teams to cover all ten districts/localities of GM.
• We will build on our experience and evidence base from the development of the Early Years
Model and Working Well and combine this with the expertise from PHE to clearly set out the
case for change.

11. The Investment Fund
• The Greater Manchester Health and Social Care MoU signed on 27 February 2015 states that
“We commit to the production, during 2015/16, of a comprehensive GM Strategic
Sustainability Plan for health and social care. This aligned with the Five Year Forward View
will describe how a clinically and financially sustainable landscape of commissioning and
provision could be achieved over the subsequent five years, subject to the resource
expectations set out in the Five Year Forward View appropriate transition funding being
available and the full involvement and support of national and other partners.”
• The proposal will set out our plans for improving outcomes and achieving clinical and financial
sustainability and will describe how upfront investment, alongside the radical changes
proposed, can enable the foundations to be in place within the five year CSR process, to
achieve financial balance.

12. The Investment Fund
• It is important that this outline plan also demonstrates how fiscal neutrality can be achieved during
the CSR period. The GM health and social care economy is not in financial balance and the gap is
projected to widen. What this work will need to demonstrate is how additional one-off investment in
the early years of the CSR period will enable the gap to be closed and financial balance to be
achieved. By neutrality it is important that the ultimate saving between the projected deficit and
achieving financial balance outweighs the level of one-off investment required.
• The recent July Budget Announcement confirms that “By the end of this year they [GM] will have a
Strategic Sustainability Plan in place to show how they will deliver a clinically and financially
sustainable set of health and social care services for the people of Greater Manchester. The
production of the Strategic SustainabilityPlan will be aligned with the Spending Review process
that applies to NHS, Public Health and local authority social care funding.

13. GM Objectives: Transforming Integrated Community Based Care and Support

14. Planned Progress by December 2015
• Dementia (September)- Work continues to define the next steps and key deliverables for this
project between the project lead and the GM Director Adult Social Services lead for dementia to
consider how to engage the wider GM system to determine what a wider transformational
programme on Dementia could achieve. The aim is to establish a development plan for integrated
services for dementia care across GM. This will feature a Salford led pilot of a whole system
change for people with dementia to scale across the whole of GM over the next five years.
• Mental Healthand Work (November) - Announcement on impacts on mental health improvement
arising from the Working Well pilot and achieve agreement on a new more intensive and integrated
delivery model for supporting unemployed residents who have a mental health-related barrier to
work by November 2015. This will build on the successes in the Working Well pilot and achieve
agreement on a more intensive delivery model for supporting GM residents who have a mental
health related barrier to work.

15. Planned Progress by December 2015
• Workforce Pilot (December) - Work continues to be progressed with GM HR Directors to develop
the passport to facilitate flexible working across organisationsand to align the work to review
agency/locumcosts with national discussions and directives. By December this aims to deliver an
agreement across providers to adopt common standards for pre-employment checks and statutory
training and agree common rates for specified targeted locum and agency staff.
• Child and AdolescentMentalHealth Services(CAMHS) – Work to agree and develop a unique,
and at scale system wide enabler to transforming Children and Young People’s Mental Wellbeing
services continues to be developed across the GM system and an update will be provided to the
September Programme Board. This will adopt an evidence based approach to developing a GM
co-ordinated approachto transformational commissioning and improve access and referrals.

16. Financial Work
• Confirm the baseline funding (£6.2bn) alongside arrangements for related funding such as from
PHE, HEE and DH
• Calculate the scale of the financial gap over the five year period until 2020/21 and then:
• Extend until 2020/21
• Specialist commissioning
• Updated provider deficit position
• Updated local authority position

17. Financial Work
• Closing the gap
– The impact of Healthier Together and further proposals impacting on the delivery of acute
services
– The impact of the proposals in the Locality Plans from the delivery of integrated health and
social care out of hospital services
– Contribution of targeted prevention and public health – including planned work with PHE
– Utilisation of benchmarking and evidence from organisationssuch as Kings Fund
Contributions fromareas such as Mental Health into Work, Complex Dependency, – use
existing CBA and related work
– Delivery of the enablers e.g. from Capital Estates and IM&T, Workforce, Contracting and
Procurement
• Quantifying the investment requirements to achieve the transformational change in the
timescales required

19. Thank you for listening
Any questions?