£100,000 to prevent falls in Greater Manchester

Establishing “a nationally leading model to connect the health and care system” – exploring the Integrated Care and Partnership Strategy for Greater Manchester

The Greater Manchester Integrated Care Partnership recently published their new strategy for the next five years. Following up from their first strategy entitled ‘Taking Charge’ from 2015, the new strategy covers the years from 2023 – 2028.

Here, we will discuss some of the strategy’s main components, as well as assessing how it will meet some of the biggest challenges facing contemporary healthcare systems.

The Greater Manchester context

The strategy begins with an executive summary, which details how although there has been good progress made since its last strategy, there remain many areas identified as requiring improvement across Greater Manchester.

“While good progress was made, including an increase in life expectancy compared to other similar areas nationally, too many people living in Greater Manchester still spend more of their lives in poor health than people in other parts of the country – serious and longstanding inequalities remain.”

Home to more than 2.8 million people, and with ten councils working together to create the Greater Manchester Combined Authority (GMCA), the vision as outlined in the strategy is to make Greater Manchester a place where everyone can live a good life in a greener, fairer and more prosperous region.

“Our Integrated Care Strategy sets out how we, as an Integrated Care Partnership, comprising the NHS, local authorities, and partners across the VCSE, Healthwatch and the trade unions, will improve health and care for the people of Greater Manchester, playing a key role in delivering the GMS.”

Working together with communities

A key aspect of the strategy focuses on providing opportunities for health and care partners to work together to face the challenges presented by the current economic climate.

“Transforming public services, integrating care to provide solutions which are more than medicine, and working with communities; not simply ‘doing to’, will fundamentally challenge our approaches to delivery and working together. The way that members of the Integrated Care Partnership work together, with each other and with our communities, will play an important part in achieving our vision.”

As a part of working together, the strategy outlines necessary behaviours including sharing risks and resources; tackling inequalities; involving communities and sharing power; spreading best practice; being open, honest, consistent and respectful; and remaining people-focused.

“This will involve rapidly increasing the level of integrated neighbourhood and locality working that connects all partners and communities who can contribute to improving health and tackling inequalities. This will move us to a stronger model of collaboration at a Greater Manchester level, ensuring more consistent and standardised responses to systemic challenges.”

The strategy notes strengths of the Greater Manchester region which will help toward working together with communities, such as existing arrangements for providers to work together effectively at scale, including with voluntary, community or social enterprise organisations (VCSE).

Managing inequality and differing health needs

The document states that Greater Manchester region is home to some of the lowest life expectancies in England, as well as some of the greatest inequalities, highlighting “differences between the most and least deprived areas of 9.5 years for men and 7.7 years for women. Significant disparities exist between and within Greater Manchester’s ten localities. In some those living in the neighbourhood with the shortest life expectancy can, on average, expect to die a whole decade before those in neighbourhoods which fare best. In some places the disparity is as big as 17 years.”

In particular, the Greater Manchester context was linked with a lower proportion of working age population with higher level (4+) skills; high levels of child poverty (26 percent) compared with the national average (18 percent); and nearly a quarter of working age adults (24 percent) being out of work.

The new strategy recognises successes including reductions in smoking, reductions in inactivity, positive employment outcomes for those with health-related barriers to work, and an increase in the number of children supported to be school-ready.

“A study by University of Manchester researchers published in Lancet Public Health shows life expectancy in Greater Manchester was higher than comparable areas between 2016 and 2019, In the short-term, life expectancy remained constant in Greater Manchester but declined in comparable areas in England. In the longer-term, life expectancy increased at a faster rate in Greater Manchester than in comparable areas. The study showed the benefits, linked to devolution on life expectancy, were felt in the most deprived localities where there was poorer health, suggesting a narrowing of inequality.”

Dealing with current pressures

The new strategy recognises the need to outline a response to some of the most pressing challenges facing health and care.

“Like all health and care systems, Greater Manchester is facing a range of challenges, some of which can be addressed within Greater Manchester while others also require changes at a national level. The impact of the COVID-19 pandemic has been huge, and exacerbated many of the challenges which were already having an effect on the wellbeing of staff and the sustainability of services.”

As of February 2023, more than 535,000 people were waiting for treatment, compared with 220,000 before the COVID-19 pandemic. Before the pandemic, Greater Manchester was already failing to meet national standards for cancer, and the surgical backlog has now meant that the equivalent of five additional theatres are now required, five days per week. Two-thirds of Greater Manchester GP practices are also reporting increased demand, whilst more than one-quarter of pharmacies and two-fifths of dental practices and optometrists are reporting challenges in delivering services.

The strategy specifically notes the increased demand for social care in the region, noting the disproportionately high numbers of children and young people across Greater Manchester who were at risk, vulnerable, or with complex needs. This, coupled with the increasing demand for, and cost of, placements for looked-after children, as well as workforce challenges such as recruitment and retention of staff, are key issues for the region.

Residents of Greater Manchester report concern about accessing GP appointments, a need for help with cost of living and preventative health, concerns regarding food security, and challenges surrounding life satisfaction and mental wellbeing.

Embedding the Greater Manchester model for Health

The Greater Manchester model for Health is designed to respond to the challenges facing the region, comprising elements designed to improve living conditions, provide proactive and preventative integrated care, strengthening communities and promoting clean air and sustainable development.

An inclusive economy, with a focus on reducing inequalities in an ageing population, is one of the key facets of the new strategy. By supporting early years development and working with councils and housing providers to improve quality of housing, as well as promoting greener spaces, the strategy hopes to increase residents’ quality of life.

The following are also factors in the strategy’s aims to tackle key challenges in the Greater Manchester region:

  • Utilising people and community-centred approaches alongside proactive primary care
  • Continuing work with integrated neighbourhood teams and primary care networks
  • Drawing on population health management tools to anticipate care needs and provide preventative care before crises occur
  • Building on digital transformation plans to help boost connectivity and improve data availability
  • Identifying those at greatest risk and supporting early detection, reducing health inequalities and addressing differences in uptake
  • Reducing harms from tobacco, alcohol and drugs, improving population health on a more sustainable basis and tackling the root causes of demand on services
  • Supporting those with complex needs and working with social care providers to improve quality of care
  • Providing support for children and young people, providing early help for families, supporting care leavers, and co-producing support for those with special educational needs

The strategy focuses on integrating care through providers, noting urgent and emergency care, planned care, end of life care, cancer care and mental health services.

It places emphasis on “transforming how people engage with health and care services digitally by bringing in new technologies and using data to provide more accurate and effective care and treatment”, along with “harnessing the power of data and technology to move beyond the basic ability to share information, to digitally reimagine services to fully support the integration of care, empower people to take greater control of their health and wellbeing and accelerate innovation into practice.”

Specific areas of focus

In order to advance health and care in the region, the strategy notes the importance of recognising the drivers of poor health and understanding the realities of everyday life for residents.

A failure to prevent illness and late detection of illness, along with addressing workforce challenges, were all features the strategy highlighted as requiring attention.

“Addressing our workforce challenges gives us our biggest opportunity to improve the way we provide health and care for our communities. The Greater Manchester public has expressed its own concerns about the pressure on our health and care workforce, in terms both of numbers and staff wellbeing. We must also recognise the additional pressure and challenge faced by unpaid carers supporting their loved ones every day; the more that stresses emerge in public services the greater the consequent demands move to families and carers.”

The document points to a need to strengthen communities and help the population to get into, and stay in, work. Planned actions include continuing to develop social prescribing in PCNs to allow people to receive advice and support within their community; coordinating response to poverty (food, fuel and transport); addressing historic under-investment in mental heath and expanding community-based provision through the LivingWell model; and embedding the VCSE Accord to grow the role of the VCSE sector as an integral part of a resilient and inclusive economy.

In addition, focus will be placed on NetZero climate change contributions, with the aim of achieving net zero carbon footprint by 2038; implementing a Greater Manchester-wide consolidated programme to deliver better outcomes for those experiencing multiples disadvantages; improving digital literacy and inclusion; and working with employers on employee wellbeing.

The partnership will also expand work and health models to prevent people from falling out of work, helping people to get back into work, and helping those with learning disabilities to enter employment, along with implementing the Greater Manchester Social Value Framework and community wealth building approaches.

Preventative health and care is an area also highlighted in the strategy.

“Many conditions which contribute to shorter healthy life expectancy are preventable. We will collaborate with focus and purpose to deliver comprehensive, scaled approaches to the main modifiable risk factors – tobacco, physical activity, obesity/food and alcohol – which can lead to death.” The strategy adds that secondary prevention will be prioritised, “treating high blood pressure, high cholesterol, diabetes and other conditions which are risk factors for poor health and early death from cancer, cardiovascular, diabetes and respiratory diseases.”

A focus on the application of CORE20PLUS5 to reduce health inequalities and drive earlier diagnosis, as well as on the expansion of culturally appropriate services to reach disadvantaged communities, are ways that the strategy aims to better tackle preventative health and care.

Finally, making it easier to access primary care services and supporting the workforce in the health and care sector were two other factors also incorporated into the strategy.

To read the full strategy, please click here.