Health Service Focus

01.12.15

Devo Manc: Making it stick

Source: NHE Nov/Dec 15

Katy Calvin-Thomas is helping lead the ‘Devo Manc’ health and social care transformation, on secondment from her executive director post at Pennine Care NHS FT.

The speed of change in Greater Manchester’s health economy brought about by the devolution agenda is startling – an initial announcement in February 2015, a plan by December and real change by April 2016. 

Katy Calvin-Thomas, speaking at a conference on the ‘Northern Powerhouse’ organised by the University of Salford, attended by NHE, said: “I don’t think there’s anything massively radical about the ideas in the plan – the radical thing is that we’re doing it at scale, across 10 areas, with 37 organisation, at a pace that I’ve certainly never worked at during my career to-date.” 

Calvin-Thomas, on secondment to the devolution team under chief officer Ian Williamson (the originally billed speaker at the conference, for whom she stepped in), began her talk by highlighting the stark health inequalities in Greater Manchester, and the fact that women in the conurbation die on average 10 years earlier than they do in other parts of the country.

She said: “This current system, no matter how hard we are trying, isn’t working – and it is continuing to consume vast amounts of resource that we know isn’t going to be there in the future.” 

She spoke of the wider detrimental impacts that poor health can have, from difficulties with employment and education to mental health problems.

‘Absolute nightmare’

Calvin-Thomas was forthright when talking about the scale of the challenge. She said: “The devolution deal around health and social care happened very quickly for Greater Manchester and I think we are still the only city that has health and social care as part of its devolution deal. 

“There’s probably a very good reason for that – which is that it is an absolute nightmare," she joked. "It is a very, very difficult piece [of work] to do. It’s absolutely the right thing to be doing, but it’s massively challenging.”

She said the fact that the initiative managed to sign up all the local authorities, CCGs and provider organisations so swiftly was a great sign, but now have to build on that work, which will “become ever more critical as we go forward into the real world next year”. 

She explained: “Our ambition is to take control of an estimated budget of about £6bn being spent on health and social care. And the strategic plan we’re in the process of writing at the moment is really built on the submission we made as part of the broader devolution and Spending Review submission in September to the Treasury.” 

Calvin-Thomas spoke of the “elusive” goal of taking activity and spending out of the acute sector and getting it closer to people’s homes, improving prevention as well as primary and community care. 

Accountability 

Governance is “absolutely critical” she said,

and that was her key piece of advice for any other areas considering a similar step. “It’s the bit that’s the hardest to agree, but it’s the bit that – when you start to talk to Treasury, or the NHS people, Monitor, the Trust Development Authority, or the Department of Health – it’s the bit they’re interested in. How do we make it stick, and how do we hold people to account? That might be our bread-and-butter in terms of our day jobs, but when we’re trying to bind statutorily independent organisations together, the governance becomes critical.” 

The key principle, she said, is that there should be no decisions made concerning health and social care in Greater Manchester “without Greater Manchester in the room”. 

Representatives of the national bodies will sit on the independently-chaired strategic partnership board, because “they need to be on our group, not thinking about us somewhere else”, Calvin-Thomas explained. They will sit alongside representatives of Greater Manchester Combined Authority, the CCGs, and the providers. 

Focus on ‘place’ not ‘organisation’ can feel threatening for the NHS 

SlideSpeaking to an audience made up mostly of businesses, campaign groups, public servants and consultants from across the region, Calvin-Thomas said: “It won’t be news to you, but something that is hard for us to think about in the NHS is the [fact that] the focus of this plan is about people and place, not organisation. The NHS, for many, many years, has focused on organisation.” 

She said the focus on people and place is “really threatening to the NHS” because the conventional wisdom for many years has been that the main provider trusts are the key, with their own governance models and wide ambitions. “We’re saying: you can still have that, but it has to be part of what we’re doing on people and place. We’re still working on that, but it’s critical to get that change and shift in emphasis, because it starts to allow you to open some doors to some conversations that we’ve not concluded before.” 

The whole plan is consistent with the aims of the Five Year Forward View, she said, as well as other recent reports like the Dalton review (on provider models) and Carter review (on NHS efficiency). 

The main aims

The first big block of the plan is a “radical upscaling of prevention, public health, social movement [and] behaviour change”, Calvin-Thomas said. That last point is an important one: moving activity and spend out of the acute sector will only work if citizens’ behaviour can be changed too. 

The plan also includes plenty of work on the primary care and community sectors, hospitals themselves, and an evidence base for better, safer, more cost-effective services. 

She said estates policy needed change, labelling it “bonkers” that the Department of Health takes the receipt when parts of the estate are sold in Greater Manchester. “We should be able to keep that within our system and do something better with it.” 

Back-office standardisation is also on the agenda, to prevent duplication across the city-region, as well as IT interoperability, information governance, data-sharing and aligned incentives. 

“The only problem I’ve got at the moment is that nationally they’re telling me that’s going to take two or three years to do, and I haven’t got two or three years to create an incentive system across Greater Manchester. But I’m sure we’ll have the brains within the conurbation to do some of that more quickly, or at least to think about it.”

IMG 0849 resize 635848247971952371

Above: Manchester City Council leader Cllr Richard Leese also spoke at the event about devolution to the city-region

Tell us what you think – have your say below or email [email protected]

 

Comments

Meltus   02/02/2016 at 18:47

I got diagnosed with Type 2 Diabetes last year, and was put on Metformin. I followed the ADA diet 100% for a few weeks but it was ineffective at getting my blood sugar below 140. My Doctor was pretty ineffective as far as treatment options went (Metformin until Insulin...). Then I found the Diabetes 60 System –https://www.linkedin.com/pulse/drryan-sheltons-diabetes-60-system-review-free-download-fazleen-fazle created by Dr. Ryan Shelton to help you figure out how to beat diabetes naturally, without being dependent on medications. Since following that protocol I've lost over 30 pounds and shaved 7 inches off my waist. I have more energy than ever, and can even work out twice on the same day when I feel like it. I hope that more people begin to open their eyes to the dead-end that is depending only on medications for Diabetes - there is a lot of success to be seen trying natural methods.

Add your comment

national health executive tv

more videos >

latest healthcare news

New agreement reached to benefit NHS junior doctors

10/09/2020New agreement reached to benefit NHS junior doctors

Junior doctors in the NHS will now also be able to undertake their training in independent hospitals after a new agreement was reached between in... more >
NHS capability for advanced therapy boosted by further investment

10/09/2020NHS capability for advanced therapy boosted by further investment

An additional £9.5m funding boost has been awarded by the UK Government into the Advanced Therapy Treatment Centre (ATTC) network. Est... more >
Identification of Covid-19 risk groups to help guide treatment

10/09/2020Identification of Covid-19 risk groups to help guide treatment

Appropriate treatment pathways for coronavirus patients admitted to hospital are beginning to be refined after research data showed people w... more >

editor's comment

26/06/2020Adapting and Innovating

Matt Roberts, National Health Executive Editorial Lead. NHE May/June 2020 Edition We’ve been through so much as a health sector and a society in recent months with coronavirus and nothing can take away from the loss and difficulties that we’ve faced but it vital we also don’t disregard the amazing efforts we’v... read more >

last word

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad, president of the Association of the British Pharmaceutical Industry (ABPI), sits down with National Health Executive as part of our Last Word Q&A series. Would you talk us th... more > more last word articles >

the scalpel's daily blog

Covid-19 can signal a new deal with the public on health

28/08/2020Covid-19 can signal a new deal with the public on health

Danny Mortimer, Chief Executive, NHS Employers & Deputy Chief Executive, NHS Confederation The common enemy of coronavirus united the public side by side with the NHS in a way that many had not seen in their lifetimes and for others evoked war-time memories. It was an image of defiance personified by the unforgettable NHS fundraising efforts of Captain Sir Tom Moore, resonating in the supportive applause during the we... more >
read more blog posts from 'the scalpel' >

comment

NHS England dementia director prescribes rugby for mental health and dementia patients

23/09/2019NHS England dementia director prescribes rugby for mental health and dementia patients

Reason to celebrate as NHS says watching rugby can be good for your mental health and wellbeing. As the best rugby players in the world repr... more >
Peter Kyle MP: It’s time to say thank you this Public Service Day

21/06/2019Peter Kyle MP: It’s time to say thank you this Public Service Day

Taking time to say thank you is one of the hidden pillars of a society. Being on the receiving end of some “thanks” can make communit... more >
Nurses named as least-appreciated public sector workers

13/06/2019Nurses named as least-appreciated public sector workers

Nurses have been named as the most under-appreciated public sector professionals as new research reveals how shockingly under-vauled our NHS, edu... more >
Creating the Cardigan integrated care centre

10/06/2019Creating the Cardigan integrated care centre

Peter Skitt, county director and commissioner for Ceredigion Hywel Dda University Health Board, looks ahead to the new integrated care centre bei... more >
Helpforce to launch training programmes for NHS volunteers

10/06/2019Helpforce to launch training programmes for NHS volunteers

Kay Fawcett OBE, clinical advisor and education lead at Helpforce, and Lynn Twinn, talent development consultant, outline the new national traini... more >

interviews

Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

24/10/2019Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

Today, speaking at the Royal College of General Practitioners (RCGP) annual conference, Matt Hancock highlighted what he believes to be the three... more >
NHS dreams come true for Teesside domestic

17/09/2019NHS dreams come true for Teesside domestic

Over 20 years ago, a Teesside hospital cleaner put down her mop and took steps towards her midwifery dreams. Lisa Payne has been delivering ... more >
How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >
Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >