Greater Manchester is pursuing the devolution of health and social care spending from the national NHS in order to improve population health outcomes. A memorandum of understanding between local organizations and the NHS outlines a process for gradually delegating £6 billion in annual funding over the next year. The goals are to integrate services, focus on prevention rather than crisis response, and empower communities through more personalized care arrangements. By shifting to a more localized system focused on social determinants, officials hope to address health inequalities and make services more sustainable for the growing elderly population.

1. DEVOLUTION & HEALTH & SOCIAL CARE
REFORM
Warren Heppolette

2. Potted history of health devolution for GM
• The opportunity is a distinctly Greater Manchester one, building on our
own track record
• Discussion with Chancellor regarding the devolution of health and
social care in September 2014
• Very positive response and suggestion of a business case for
investment
• Initial focus was on this business case and the opportunity to receive
some additional non-recurrent funding
• NHS England initially surprised but subsequently very enthusiastic
• A bigger and more comprehensive devolution agreement between
Greater Manchester and NHS England now a real prospect with
agreement to work together set out in a memorandum of
understanding.
2

3. The devolution of health and social care has made national headlines;
illuminating both the opportunity but also the expectation
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Health devolution for Greater
Manchester
25 February 2015
Greater Manchester is to become the
first region in England to get full control
of health spending.
Greater Manchester £6bn NHS budget
devolution begins in April
27 February 2015
Greater Manchester will control a
combined NHS and social care budget of
£6bn
Greater Manchester will begin taking
control of its health budget from April
after a devolution agreement was signed
by the Chancellor George Osborne.”.
It's a historic day for Manchester, but not a 'town
hall takeover'
27 February, 2015 | By Crispin Dowler
NHS insiders in Greater Manchester have been
pleasantly amazed by the speed at which
negotiations progressed leading up to today’s
historic agreement to devolve and integrate £6bn
of health and social care spending for the
conurbation.
Revealed: Details of £6bn Manchester health
devolution plan
25 February, 2015 | By James Illman
Radical plans for Greater Manchester to take
control of £6bn of health and social care spending
will be overseen by a new statutory body from April
2016, according to draft plans obtained by HSJ.

4. What does Devolution offer?
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The overriding purpose of the initiative
represented in this Memorandum of
Understanding is to ensure the greatest
and fastest possible improvement to the
health and wellbeing of the 2.8 million
citizens of Greater Manchester (GM).
This requires a more integrated
approach to the use of the existing
health and care resources - around £6bn
in 2015/16 - as well as transformational
changes in the way in which services are
delivered across Greater Manchester.
……A focus on people and place

5. Objectives
– Improving the health and well being of GM residents from early
age to elderly - recognising will only be achieved with a focus on
prevention of ill health and promotion of well being
– Moving from having some of the worst health outcomes to
having some of the best and closing the health inequalities gap
within GM and between GM and the rest of the UK faster
By:
• Integrating care for a more holistic, co-ordinated approach
• Putting experience of patient, carer and families at the centre of how
services are organised and delivered.
• Making best use of existing budgets, including to improve performance
around reducing pressure on A&E and avoiding hospital admissions,
where appropriate.

6. The MoU
• Framework for delegation and ultimate devolution of health and social care
responsibilities to CCGs and local councils in GM
• Sets out process for collaborative working from April 1 2015 and work needed
during 2015/16 to achieve full devolution and/or delegation in April 2016
• Agreement for parties agree to act in good faith to support the objectives and
principles of the MoU for benefit of GM patients and citizens
• Includes all local authorities, all GM CCGs and NHSE
• GMNHS Trusts, Foundation Trusts and the NW Ambulance Trust issued letters
of support
• Allows GM to reshape how health and social care services are delivered -
estimated budget of £6 billion
• Services will stay as part of the NHS or Councils but will be tailored to reflect
needs of residents
• CCGs and Councils will keep existing accountabilities, legal obligations and
funding flows – ie responsibility for NHS funding stays with NHS and for local
authority funding with local councils (not CA)

7. Principles
• GM remains within NHS and social care system - uphold standards in
national guidance and statutory duties in NHS Constitution and
Mandate - and for delivery of social care and public health services
• Decisions will be focused on the interests and outcomes of patients
and people in GM - organisations will collaborate to prioritise those
interests
• Decision making underpinned by transparency and open sharing of
information
• From 1 April 2015 ‘all decisions about GM will be taken with GM’
• GM will work collaboratively with local non GM bodies and take into
account the impact of their decisions on them and their communities

8. But devolution is the mechanism, not the master…
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What are the issues we need to respond to…?
….devolution can be the trigger for greater and necessary positive reform
A growing
ageing
population
Poorer health
& growth in
chronic
conditions
Instability &
fragmentation
in the health &
care system
Consequences
• Unplanned,
Haphazard
change
• Poorer care
and treatment
• Difficulty in
meeting future
health needs
• Failing the
health & care
workforce
Increasing pressure on health & social care

9. What does radical reform look like?
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• Shifting the balance of investment
towards proactive, early help and
away from a crisis response
• Health & care defined by an
approach based on prevention
• Intelligence led, highly targeted
preventative action based on a
deep knowledge of our
communities and their strengths
• More integrated public services
responding to all forms of
vulnerability
• Increased healthy life expectancy

10. A different approach to reform…
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“One of the great strengths of this country is that we have an NHS
that – at its best – is ‘of the people, by the people and for the
people’. Yet sometimes the health service has been prone to
operating a ‘factory’ model of care and repair, with limited
engagement with the wider community, a short-sighted approach
to partnerships, and under-developed advocacy and action on the
broader influencers of health and wellbeing. As a result we have
not fully harnessed the renewable energy represented by
patients and communities…”
(NHS Five Year Forward View)

11. Making it happen
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EVIDENCE EXAMPLE
In Wigan a new asset based approach to
communities and individuals has been
trialled and rolled out across the Borough.
Deeper conversations with residents
enables greater insight and understanding
of what is important to the individual
resulting in innovative alternatives to
formal care that can be accessed through a
personal budget. It also enables the
identification of root causes of anxiety and
addresses wider issues such as social
isolation. It ensures that consideration is
given to carers and wider support
networks. Initial evaluation of the work
indicated 76% of the cohort did not require
any further social care support, 56% were
not in services 6 months later and
51% were still independent 12 months
later.
Overarching shift from dependence on traditional
health and social care services to enabling
independence and self reliance
• ‘Different conversations’ with residents to better
understand individual assets, recognising strengths,
gifts and talents.
• Connecting to and building community capacity to
respond to needs:
- Mapping and utilisation of community assets
- Community hubs and micro enterprises
- Use of new technology and value exchange
- Step change in volunteering
• Developing new ways of working to deliver the
above