Co-chairs Councillor Zahid Chauhan and Councillor Jo Harding

In attendance: Michael Kelly, Wyn Dignan, Cllr Riaz Ahmed, Gill Campbell, Karen Atkinson, Caroline Bedale, Rob Ward, Peter Firth, Wayne Shields, Ivan Lewis MP, Mike Livingstone, Martin Yuile, Martin Rathfelder, Cllr Abdul Jabbar, and Annette McKay

Opening remarks and purpose of meeting: Ivan Lewis is running to be Labour candidate for Greater Manchester Mayor. He has worked in social care since he was 19 years old when he set up a charity in social care. He has also served as a Minister in the Department of Health where he brought to light the low status of social care and the need to integrate the NHS with social care, as well as focusing work on an ageing population and the first ever dementia strategy.

Ivan will personally lead on mental health which is a scandal across Greater Manchester. He will fight for more resources to tackle the £2 billion black hole in the NHS budget, and the already slashed social care budgets.

In addition to this Ivan paid tribute to the excellent Strategic leadership Lord Peter Smith has shown around the Health and Social Care agenda within our conurbation.

Devolution could be the most important decision of our lifetime. There is huge health inequality across Greater Manchester, and seemingly better off communities still have their issues. Devolution must work for the whole of Greater Manchester. If it doesn’t, people will become disconnected and the project will fail. There are concerns around funding and deficits in the acute trusts and we need more scrutiny. We need to make sure that our workers are retained, valued and trained. Public health is critical as is asking people to take charge of their lives.

However Devolution is a great opportunity. Decisions made at a local level are the best ones. We must use these new powers to fight inequality. We have a chance to make a real difference on prevention and early Intervention. We must look at housing and include the voluntary and community sector as well as professionals and patients. There must be no collusion with the Tories for further privatisation in the NHS.

The Integration of services must be bottom up and designed to give people maximum control of their lives and their health. The system should support them at every level to make the right choices.

We need to show capacity to be innovators

Staff and frontline workers

There are still some reservations about the devolution deal and the impact it will have on workers’ rights, pay and training. Though there is already a vague protocol, staff in NHS and social care need guarantees for their terms and conditions.

Cutting pay is a simple way of enacting the cuts but short- sighted. So is relying on volunteers or charities to pick up the roles that paid staff are doing at the moment. They do have a role in delivering services (for instance peer mentoring) but need paid support in order for it to work properly.

We need to protect national pay rates and national training standards and not allow our services to be damaged by lack of investment in our staff.

The deal as it stands

No one disagreed with challenges and aspirations set out in the Memorandum of Understanding. However there needs to be more clarity for who is responsible for the deficit and what happens in pandemics.

There is a lot of wishful thinking, without clear ways the deal can be delivered, and without an understanding that both our Health and Social Care are at breaking point and only have capacity for crisis management. It presumes that everyone needing help is already receiving it and therefore efficiencies can be made to cut the cost. In reality there are still a lot of people out there not accessing services and efficiency will just free up more resources to increase number of people being reached, not cost less.

Already services like mental health have had large cuts to their services. Devo Manc could see the Break-Up of the NHS which could mean we lose national standards, pay agreement and training. We need to make local decisions but maintain national standards.

In practice what’s the difference from Whitehall to Manchester Town Hall? We need more transparency instead of a handful of people making the decisions. We need the general public and local authorities to be involved, not just the leaders.

There is a shortfall in resources to deliver these changes.

The challenges

At the moment CCGs are in consultation, but the process is not outcome driven. Most people know what they can do to live healthier lives yet they don’t stop drinking, smoking, or take more exercise. Why? It’s too hard, they are too stressed; there are other factors at play. The system is not structured to deal with these factors.

We want to give staff a decent wage, especially in social care. Changes to terms and conditions like this are not in the deal but will cost extra money.

We must make sure that money isn’t spent on buildings or projects that look good for politicians; but on patients.

We need solutions not crisis management.

Solutions and opportunities

Money is wasted in the NHS with an over bureaucratic tendering process for service tendering. One recent example was the need for a 45,000 word bid for work. This is money that could and should be spent on patients. Not anti-competition but pro-collaboration.

Keep away from expensive pilots like 7 day GP opening.

Precision public health – the health engine is a driver to bring together all the parts of public health. If we put obesity as a national risk, we can use this to address a lot of other health problems too.

Social care is commissioned by local authorities but there is no consistency on how the systems work. We could bring a consistency into bidding and delivery that will create efficiencies.

There already is a postcode lottery for health and social care across Greater Manchester. Devolution can address that by setting a minimum standard of service and consistent key indicators for outcomes.

Patients should have one key member of staff who they deal with, rather than a multiple of agencies they deal with. Evidence shows this is really how we tackle problems around substance misuse for example. We need to make sue the service is built around the individual because having many different professional bodies involved is just wasting money.

The Voluntary sector is a good way to consult with communities. Not all CCGs work with the voluntary sector but involving them at the beginning not the end of a process can avoid loss of time and expensive mistakes.

There are opportunities to tie health to Local Authorities in a more effective way. Oldham has recently opened a new leisure centre. This can be used in innovative ways for rehabilitation, public health etc. In addition, working with Councils may show new and innovative ways of working. Councils already have to do this in the face of massive cuts to funding.

The Fire and Rescue service in Greater Manchester have changed their focus to prevention and with great success. We can transfer that principle into health with Fire and Rescue service as a critical friend. There are ways to collaborate with delivery, not to take jobs or budgets from the NHS and social care. They need to maintain core workforce in case of emergencies, but so much more they can do to help.

The ambulance service is already doing a lot of health care. Only about 5% of the time is spent on ambulance emergency work. The rest is health provision at people’s homes or over the phone. This helps with capacity at hospitals but more can be done. Sometimes ambulances are queuing for 2,4 or even 6 hours which could be time spent elsewhere.

This waiting could be due to hospital inefficiency or more money needed. But more can be done. Paramedics are skilled clinicians. With extra training they could provide more out of hour’s service. Hospitals or walk in centres could commission paramedics to relieve pressure. The ambulance service can be used to put care back into the community.

The health system doesn’t change easily. It’s very evidence-based and sometimes you just need to take a leap of faith.

Money at the moment primarily follows treatment not prevention (with some exceptions). We can redirect funds to drive outcomes we want. This can also be done with check-ups and scans from birth or even before.

A lot of ill health and social care needs are connected to housing and poverty. A lot of poverty is hidden but it is there. People feel under siege and make bad health choices and treat NHS staff badly. Addressing poverty can help health outcomes.

In a critical case of a heart attack one person had suffered, care was given by the community – paramedics – doctors- physios – Community-Self, in that order. We should do more to increase the community and self-care. For instance life-saving should be on the national curriculum.

The ambulance service currently has 2000 trained volunteers to use defibrillators, but what other care can be offered using a similar model?

Conclusion

An elected Mayor should give leadership on these changes with a clear delivery plan. We must close the reality and rhetoric gap when discussing integrating and service delivery.

Communities, voluntary sector, charities, patients and professionals should be involved. At the moment this is being done about us but without us.

Ivan will hold further seminars on health and social care to widen the input but building on this summit and hopefully attendees can make future events too.

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