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09.06.17

First signals of Manchester STP impact due next year as LCOs take root

Greater Manchester’s health and social care system will start, from this year and into the next, to really see service changes materialise before the first signals of the impact of devolution emerge at the back end of next year, one of the system’s bosses has revealed.

Speaking this week at a King’s Fund summit on sustainability and transformation plans (STPs) at Manchester Metropolitan University, Warren Heppolette, executive lead for strategy and system development at the GM Health and Social Care Partnership (GMHSCP), also revealed that the first three or four local care organisations (LCOs) in the region are now finally being mobilised.

LCOs are largely heralded as the government’s preferred integration model, bringing together local government, NHS providers, commissioners and the wider public service spectrum to secure a “proactive, preventative population health model”.


Late last year, NHE reported that Manchester had become the latest of the region’s 10 localities to submit development proposals for its LCO, meaning the city was on track to establish a new model expected to shift care and resources from the acute sector into a “strengthened model” of health and care within the community.

Heppolette himself described LCOs as “the most significant change” across the region’s entire health devolution portfolio.

“We have three or four of these that are now being mobilised,” he told the audience. “It has to be more than integrated health and social care: it has to be the magnet for a wider public service connection and it has to be a place where we actually start to formalise our relationship with the voluntary and community sector.”


Part of this work includes recognising that it’s impossible to integrate health and care just at a Greater Manchester level, he said: “We have a connected conversation recognising that there are certain characteristics of those models that stay constant, and a framework we will collectively eschew across GM – we’ve done a lot of work around common purpose and the scope of characteristics of those LCOs.

“But there will be differences locally, and these have to be built and activated locally.”

Overall, added Heppolette, the 10 LCOs will become “fixed parts of the way we work and exist in GM” when it comes to health and care integration across localities, adding: “We’ll start to see over the next year a stable but real establishment of the 10 LCOs. That will be critical: that’s the bit that insulated us from the future top-down model, because this will be a bottom-up development.”


With regards to the region’s STP – which was actually written before NHS England’s Five Year Forward View formally established the STP programme on a national scale – GMHSCP decided early on that there would need to be some quick wins that could already “embody and characterise the changes” foreseen over the next five or so years.

“We took, in the first six months post-devolution agreement, some steps to introduce some changes that we thought would give people a flavour of what we thought was going to be around,” said Heppolette. “We took some early decisions on extended access to primary care, some early decisions on standardising clinical practice in hospitals, and we established Health Innovation Manchester as a single connected way of us joining our academic institutions and our academic excellence in Manchester with industry and with the mainstream health and care system, so that we could shorten the time from discovery to mainstream spread.

“There are a range of steps we took early on in the process that just helped to build a bit of credibility and start to actually make some of the changes, recognising that we were on a planning journey.”

He later added: “I’m really clear that we’re in year two of a five-year journey, and if I’m being honest, what characterises year one and year two is the focus on infrastructure development, which is the technocratic way of saying that it’s the focus on relationships, getting systems to live with each other and rethinking the way they interact.

“We’ll start, from this year and into next year, to really start seeing the service change, and I think towards the back end of next year we’ll get some first signals on impacts through our evaluation.

“The key bit here is that this is where we’ll see the early stories of integrated services operating, around new service models being created and new insights on the impact of those models start to come to life.”


GM’s newly elected mayor, Andy Burnham, is also expected to play a major role in the region’s health devolution process. While Heppolette heralded the system a “game changer” in itself and praised the existing publicity around it – GMHSCP livestreams every board meeting, for example – his expectation going forward is that the mayor will add to this transparency.

“We’re undergoing a process now where we’re trying to connect where some of the ambitions of Burnham’s manifesto sit with some of our health and care ambitions,” he explained. “So this feels like it’s solidifying and making irreversible some of the changes that we’ve made, so we then get that confidence that actually, we’re not in a 2-3 STP journey here: we’re on a system journey in GM around radical improvement of health and care.”

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