Greater Manchester: 30 years ahead

Source: NHE Dec/Jan 16

Jon Rouse, the new chief officer of Greater Manchester Health and Social Care Partnership, speaks to NHE’s Luana Salles about the region’s latest and forthcoming integration developments.

Greater Manchester’s (GM’s) devolution has been a long time coming: when Margaret Thatcher broke up the region’s metropolitan county council in 1986, the north resisted centralised control, setting up the voluntary Association of Greater Manchester Authorities that same year. Effectively, this means GM has been sitting on 30 years of joint working experience. 

This strong foundation had already been praised by the city’s outgoing council CEO, Sir Howard Bernstein, and is now being reemphasised by the region’s Devo Manc boss, Jon Rouse. Speaking to NHE in the headquarters of Greater Manchester Health and Social Care Partnership, the organisation’s new chief officer reiterated that when the region’s combined authority was formed in 2011, and its health devolution deal agreed last year, it was coming over “all these layers of experience and confidence”. 

In practice, this also means that despite the £6bn health devo deal only having formally started in April, GM has been engaging in place-based health for around 18 months. 

The story so far 

Describing the latest developments in this journey, Rouse had much to pick from: the bespoke Dementia United programme has just agreed a set of standards along a whole care pathway, which will be implemented across all 10 localities; different models of seven-day primary care access are now available across the board; population health programmes are being accelerated alongside local care organisations (LCOs); work on acute standardisation, consolidation services, estates reforms and digital work are all live and moving forwards; and the list goes on. 

“There’s pretty much something new or coming to fruition at least every month, I would say,” he said. “And every single one of our programmes and projects has to have an appropriate public engagement strategy around it.” 

Rouse accepted that it was also a case of ‘learning as we go along’, noting: “We’re very aware of the fact that a lot of what we’re trying and testing is being done for the first time. But what we do tend to find is that there is usually an example of it being done before somewhere in the world – maybe not in totality, but we can usually find at least some examples. 

“For example, we have a really nice dialogue going on with New York State about the development of our LCO, because they already have 50 accountable care organisations and they’re very open to doing some mutual learning.”

As well as learning from national and international partners, GM is also interested in sharing its successes domestically. “We’d be very happy to tell the story about any one of these localities in terms of what they’re doing, both their strengths and weaknesses,” said Rouse. “Our spirit is of openness.” 

NHS and local government 

Asked about the progress with NHS and council collaboration, Rouse argued it’s been great so far. “On the commissioning side, we’re making good progress on all localities around expanding pooled budgets and integrating commissioning apparatus, whether that’s a joint commissioning board, a single commissioning organisation, or in some cases effectively doing away with the CCG/local authority divide and creating one commissioning mechanism,” he said. 

“On the provider side, in terms of the medium-term vision it’s all going really well, partly because of the transformation fund resources that add engine oil to the machine. It means that not only can we come up with a plan, but we have a mechanism for actually financing that plan, double running services and so on.” 

He did admit that there have been some tensions around the day-to-day operation of the urgent and emergency care system, particularly with delayed discharges. In GM, as with the rest of the country, this has mostly boiled down to council finances. 

“We’ll continue to make a case to government for the need of additional social care resources,” Rouse stated. “If there was any chance for any additional resources [in the Autumn Statement] our first priority would be for social care, no question.” 

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Collectiveness and co-location 

Across the NHS, commissioners are “working really well together”, said Rouse, who claimed he has been really impressed thus far: “We now have a joint commissioning board, so they can actually do things together and make decisions together.

“Taking on specialised commissioning has been interesting, because rather than us just absorbing that ourselves, we actually have lead commissioners out in the CCGs. They get to do more, and that makes their jobs intrinsically more interesting. For example, Trafford leads on cancer, South Manchester leads on learning disabilities, and so on. They have enhanced roles as a result of us taking on these increased responsibilities.” 

He was also pleased with the provider side, particularly with the response so far to the CQC’s report into Pennine that forced in an Improvement Board to support the acute trust. While Rouse acknowledged that the provider’s ‘inadequate’ rating was evidently a problem in itself, he was proud of the collective GM-wide response it had triggered, with Central Manchester University Hospitals NHS FT providing maternity services in North Manchester General Hospital and South Manchester freeing up consultation sessions to help out with Pennine’s A&E. 

He owed this not only to Sir David Dalton, Pennine’s CEO, who is also the boss at Salford Royal NHS FT, but to the Provider Federation Board, which brings together leaders from all 15 trusts, underpinned by a group for directors of operations and of finance. 

“And one of the most important things that has happened in my time here is the agreement from NHS Improvement (NHSI) – and [Jim] Mackey must take a huge amount of credit for this – to allow the NHSI director responsible for GM to be based here, and to have a place in my senior management team as well,” he added. “The dynamic that creates through co-location, a sense of shared responsibility, is just fantastic.” 

The immediate future

To summarise the region’s long integration journey thus far, the partnership will publish a six-month report in late November listing how GM is faring in terms of performance, quality, finance and transformation – its four pillars – since devolution kicked off.

Meanwhile, advancements across all four categories will also continue at pace, with a special focus around navigating winter for the time being – but “in a way that doesn’t upset medium-term objectives around changing the model of care”. GM has also been able to scoop up a few areas of underspend in order to create an extra winter fund to support A&E departments. 

Elsewhere, the partnership has a number of forthcoming programmes that have a “very deep quality focus”. Its cancer strategy is due to be published in December or early January, and some key programmes in its mental health plan are coming “to a really critical point in terms of decision-making”. Work around crisis care for young people and perinatal is also expected to come forward in the next couple of months. 

On the finance side, there is relentless focus on planning and getting control totals sorted by the end of December, working through contracting, and setting out GM’s specialised commissioning programme for the next two years. 

Finally and perhaps most importantly, transformation schemes are moving swiftly, with the region’s population health plan going to the partnership’s board in December. Rouse’s team is also currently assessing LCO bids from Wigan and Manchester; moving forward on proposals to create a single Manchester hospital service; preparing to sign off the memorandum of understanding with Health Education England on workforce; and developing a number of work streams around acute standardisation and collaboration – namely around paediatrics, vascular services and coronary and respiratory services. 

“All of that is moving forward,” said Rouse, “and yet there are still things I haven’t even talked to you about.”



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