DevoManc “Implications for Health and Social Care”

David Jones

Consultant General and Colorectal

Surgeon

University Hospital of South Manchester

RCS North West

Director of Professional Affairs

djones1@rcseng.ac.uk

@jonesthesurgeon

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Conflicts of interest

• RCS North West Director of

Professional Affairs (DPA)

• Member of Healthier Together

• Clinical Advisory Group

• Consultant Surgeon

• Wythenshawe Hospital (UHSM)

• Judicial Review of HT decision by

Consultants (9th and 10th December 2015)

for Wythenshawe Hospital to be a local

rather than Specialist site

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@GMHSC_Devo #GMDevo

To ensure the greatest and fastest possible improvement

to the health and wellbeing of the 2.8 million citizens of

Greater Manchester

Political background

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Manchester City Council

96 councillors

(96 Labour)

Greater Manchester (DevoManc)

10 Metropolitan boroughs

8 Labour

1 Conservative

1 Liberal Democrat

• Greater Manchester

Population 2.8 million

£6b Health and

Social Care budget

Similar budget and

population size to

Wales and a little bit

bigger than Anglesey

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• 2. 8 million population

• £6b Health and Social

Care budget

27th February 2015

Manchester Town Hall

@GMHSC_Devo #GMDevo

Who will be responsible?

10 Borough councils

CCGs

Interim Mayor

NOT responsible for health

Risk assessment

• Central government will still have the power to cut

local authority funding, as it already does in the

name of austerity, but no responsibility when

councils have little choice but to cut health care

services

• Ultimately most services are locally delivered by

relatively autonomous professionals whose

commitment to a new strategic vision needs to be

secured

• Guardian: March 2015 9

Early implementation priorities

for DevoManc • 7 day access to primary care

• Academic Health Science System

• Dementia Pilot

• Workforce policy alignment

• Public Health Programme

• Healthier Together

• Mental Health and Work

• Children and Young Peoples’ Mental Wellbeing

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11

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Real-terms expenditure

(£s billions) % change

2010–11 2014–15

England

Health 105.3 109.9 +4.3%

Social

Services 24.6 21.8 -11.5%

Wales

Health 6.48 6.35 -2.0%

Social

Services 1.60 1.58 -0.8%

Institute for Fiscal Studies

• Welsh Government

• less protection to health

budgets

• Smaller cuts in social care

• Institute for Fiscal

Studies 2015

• Cardiac surgery waiting times!

• Highlighted by Welsh RCS

Professional Affairs Board

Differences with Devolution

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Plans for Manchester

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By 2020

64,000 lees with chronic conditions

10% less visits to urgent care

6000 less diagnosed with cancer

25,000 with mental illness benefit

from better community care

18,000 children better supported

by local services

700,000 with chronic conditions able

to manage own health

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All hospitals in Greater Manchester with an

acute take are in the “red"

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North of England

Commissioning Region

July 2015 – Sept 2015

4919 cancelled on the day

NHS England Statistics

Delayed discharges awaiting

social care support in the community

Do we need to spend more on

Social care and less on healthcare?

Social care budget cuts in the North East

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Priority 1

“Advance standards and reduce

variability in patient outcomes”

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Wide variations in treatment of

haemorrhoids!

Commissioned activity for haemorrhoids

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5 fold variation

In Greater

Manchester

Adjusted 2 year mortality rates by Trust

Reflects all aspects of care?

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Wider variation in outcomes

North West: 2 year adjusted mortality

Is it still the same teams operating?

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39

34.7 33.9

30.6

28.6 27.9 27.8 27.2 26.9 26.7 26.1 25.9 25.1 24.9 24.2

22.7 22 21.6 20.9 20.7

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14.3

0

5

10

15

20

25

30

35

40

45

I N E T U M Q A C L J O R F B V D H S P G K

2 year mortality

2 year mortality

North West - Rectal cancer:

APR rates

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0

5

10

15

20

25

30

35

40

45

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J A M D H R C N T F Q E L B P U K I O S G V

Rectal Cancer – North West

Stoma rates at 18 months

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0

10

20

30

40

50

60

70

80

E A Q D F B G U C J L T I V M S R P N H K O

Stoma at 18 months

Rectal cancer: North West

Variation by in APR and stoma rates by Trust

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• 6 fold for APR rate

• 1.5 fold for stoma

• Quality of life with stoma

may differ if an end

colostomy or “temporary”

loop ileostomy

• Quality of life after

anterior resection?

• Patient selection

• MDT

0

10

20

30

40

50

60

70

80

J A M D H R C N T F Q E L B P U K I O S G V

APR Stoma at 18 months

Large bowel obstruction

Surgery or stenting

Temenos (A sacred piece of ground)

Anish Kapoor

Middlesborough

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Clinical needs

Value for money

We do a lot of operations

Are they all needed?

0 50000 100000 150000

Hernia

Hip replacement

Knee replacement

Cholecystectomy

Tonsillectomy

PROMs – Improvement rates (hscic data)

Worsened Improved

Priority 1

“Advance standards and reduce variability in

patient outcomes”

Devolution will focus minds?

Early implementation priorities

• 7 day access to primary care

• Academic Health Science System

• Dementia Pilot

• Workforce policy alignment

• Public Health Programme

• Healthier Together: Single service provision

• Emergency, Acute Medicine and General Surgery

• Mental Health and Work

• Children and Young Peoples’ Mental Wellbeing

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Healthier Together • 4 Single services

• Specialist and Local General Hospitals

• High risk elective and emergency general

surgery on the Specialist site

• Staff work and train in a single service rather

than a specific site

• Emergency medicine, Acute Medicine and

General Surgery

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Which hospitals are General and

which are Specialist?

There are

8 options

Hospitals not under review

Hospitals under review

There are 10

hospitals in

scope

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Healthier Together

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“DevoManc”

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