Blog by chief officer Jon Rouse
Today we publish our Population Health Plan for Greater Manchester. We are a city region that has grappled with public health challenges for centuries – from food riots to cholera, from overcrowding to addiction – reflecting the stresses of change and development across our settlements which are home today to some 2.8 million citizens.
Many of the challenges of the past were a product of rapid economic changes, the rise and fall of heavy industries, the aftershocks of which are still felt in many of our communities. In the midst of shifting national and global markets, we have experienced the additional stratum of over seven years of austerity and its consequential impact on public services, particularly in our more deprived neighbourhoods.
Our Population Health Plan therefore stands on two pillars – the drive for economic development and growth, and our deep commitment to public service reform. We strive to make the very most of our total public service offer to equip individuals and communities to connect to the growing economic opportunities that this city region is generating. We want people to feel and to be empowered to take more charge of, and responsibility for, their own lives, to have more control and more choice to influence their own health and wellbeing.
The Plan is guided by a set of principles of how we can best support the population in maintaining and improving their health and wellbeing. They are: a preference for community-based models, an adherence to evidence-based interventions, a commitment to parity of esteem between physical and mental health, and belief in the merits of a life course approach.
Together, these have given rise to twenty programmes that we will roll out over the coming year.
Our Plan embraces the concept of asset-based community development as a way of doing business. It is an approach that recognises and celebrates the heterogeneity of our individual communities and neighbourhoods, including communities of interest. It is a model that seeks to identify the inherent strengths of those communities and to use the total weight of public expenditure and a doctrine of social value to build on them, working always in close partnership with the voluntary community and social enterprise sectors. Within this model we emphasise the role of community anchors, institutions that are already respected and trusted within the community. One common set of anchors are our primary care providers and so one of our programmes seeks to support GPs and their partners by giving them more options in caring for individuals with multiple needs, including the creative use of social prescribing.
In developing our Plan we have been rigorous in sifting the evidence to ensure that we are pursuing the right programmes for our population. For example, we have far more smokers in Greater Manchester than most other parts of the country with major impacts down the line in terms of prevalence of long term conditions and incidence of cancer. As well as committing to overhauling our overall tobacco strategy we will be introducing at pace a specific programme targeted at smoking in maternity, recognising it as a pivotal moment in terms of behavioural change, and also the importance of seeking to protect the unborn child.
Greater Manchester is committed to the goal of parity of esteem between physical and mental health, and that includes our preventative programmes. For example, we will adopt a holistic approach to our early years programme, working across universal and targeted services to influence the physical, mental, emotional and cognitive development of the young child. And under our ‘Live Well’ theme, we will introduce an expanded Work and Health programme that provides rapid access to both physical and mental health services to enable people who are struggling to stay in work or get back into work quickly.
Our life course approach extends into old age and end of life. Again, following the evidence, we want to focus on falls prevention and supporting good nutrition and hydration. In pursuing these goals we will want to make every contact count, for example through the extensive programme of home visits that our Fire and Rescue Service provide each year under their ‘Safe and Well’ programme.
Many of the interventions under our Population Health Plan will be delivered at a local level, often as an integral part of the work of our emerging Local Care Organisations. But where it makes more sense we will operate at Greater Manchester level to ensure consistency of approach and to secure economies of scale. Our overall aim is to achieve a unified population health system. That is why it is so important that organisations like Public Health England are part of our Partnership and that we have devolved authority over the delivery of programmes such as vaccinations, immunisations and screening.
Our Plan is unapologetically evidence-based but that does not mean there won’t be space for innovation. Whether it’s our cancer champions programme, based on the development of a social movement, or our commitment to embrace the power of digital technology in influencing individual behaviours, we will work with our universities and wider research community to push forward thinking about the design of a system based on a philosophy of ‘prevention first’. Fundamentally, this should mean moving power from the State to the individual, who will be increasingly well equipped with the information and support to make positive life choices that lead to enhanced life chances.
We are under no illusions that we are pursuing this Plan in the prevailing wind of austerity. Over the next five years we still have a financial gap of over £1 billion to close in terms of our NHS and social care pressures. To put it simply, when we took charge we were spending beyond our means by £200 every minute; if our plans don’t work this will have risen to £2,000 a minute by 2021.
In these circumstances the temptation is always to seek to deal with the flood which is upon us now. To rush out with some sandbags so we can be seen to be taking decisive action, even though we know the waters are still rising and our defences will ultimately be overwhelmed.
So yes we have to act, but we have to be brave too and invest some of our transformation resources far upstream. The impact and benefit of this won’t be seen or felt straight away but we know it will be the determining factor in whether we can secure a sustainable health and care system.
With the publication of this Plan we now move into a crucial delivery phase. We have programmes to set up and others to strengthen. As we move forward, our constant references will be back to the outcome measures we have agreed as Partnership, measures that reflect the priorities which matter to the people of Greater Manchester – better education, more jobs, more housing and of course improved health. Our goals are stretching, including a huge reduction in smoking prevalence, a reduction in suicides and contributing to the eradication of HIV in a generation. But what underpins all of them is a shared passion to reduce inequality; to release the dividend of a healthier population to the further growth and cohesion of our great city region.