Read Manchester Local Care Organisation chief executive Michael McCourt's blog on the first months of operating as MLCO and his hopes and ambitions for services in the city.
Manchester Local Care Organisation went live on 1 April 2018. I want to say a little about where we are up to almost two months in and, to finish the blog, share some personal reflections on the challenges ahead.
A big thank you to all those who made MLCO happen - and an even bigger welcome to all those who will work with and within it. MLCO is a partnership organisation of statutory and non-statutory services providing a wide range of care services.
So what does that mean? It means, for the first time ever, Manchester has set up a new organisation to deliver integrated care services across all of Manchester. This is the start of moving from fragmented services across lots of different providers, to providing an integrated arrangement of services across all ages and for all people with care needs in their communities.
Principally we have been asked to:
- Make a positive contribution to help people in Manchester live longer and enjoy better health than many do now
- To improve community and neighbourhood care for people in Manchester.
From 1 April we now lead community health services, adult social care direct services, some public health services and a range of new models for providing care. Over the coming year, we are expected to put in place a programme that takes us from our starting point now, to our full ambition for MLCO. The vision for this was set out in the Manchester Prospectus in November 2016 and we will use this as our guide as we build the LCO with commissioners and provider partners.
We are developing the strategy and programme to take the MLCO from its current £170m form, up to potentially more than £700m of services, contracts and care provision. I believe it is only at that bigger scale that can we really start to deliver the better outcomes Manchester needs.
I would summarise bigger scale as four key areas we need to build the best arrangement of services and activities around care;
- Prevention services - helping people to stay well and help people get early treatment for any health conditions they may be developing
- Neighbourhood services - building vibrant community neighbourhood care through integrated teams, joining up services to make care simpler and more effective for people
- Keeping people well - helping people who have existing health needs and maybe some complex health issues, to stay as well as possible in their home. If somebody does need care we should provide it in their home, if this moves into nursing home care it should be still promoting their independence as far as possible
- Ensuring people only have hospital care for as long as they need it - too many people stay in hospital for too long, Manchester LCO will need to play a key role in creating a step change from hospital care to better and more effective alternatives. We are creating a ‘bundle’ of care services which aim to help people avoid getting into hospital; and get them out quickly if someone is admitted when they do need that specialist care in hospital.
All of the above will need underpinning by sustainable primary care, integrated care teams, effective care management between hospital and home, and direct work with the people of Manchester on their health needs so they can take charge of their own health. We will also need the right buildings to work from, significant advances in how we use digital systems and technology, and a lot of system and organisational development.
Importantly, very importantly, we need to enable the community health and social care workforce to lead and ensure the expertise in Manchester has a voice that influences how we plan and change in the months and years ahead.
Taking things forward
It should be straight forward then shouldn’t it? Well we know that isn’t the case, so I thought I would share my thoughts and reflections on where we have got to and what’s needed next.
Firstly, I feel very lucky and privileged to have had the opportunity to lead MLCO developments since January 2017. It is immensely rewarding to have achieved the start-up of the organisation. Yes, it hasn’t been straightforward and no, it isn’t exactly as I had envisaged. But it is live and has all round support to bring about the developments and changes we need.
Manchester knows it needs better community care and the people who live in Manchester need to have the best opportunity to live longer and healthier lives than many do now. I think to get there we need some clear value drivers (the why we need to do this) alongside some big goals (the what we need to achieve) and a plan everyone can follow and understand (the how).
Why we need to do this has been commented on. People in Manchester do not live as long as people elsewhere. This cannot continue in a fantastic city that has grown and prospered in so many ways except the health of its residents.
Equally, people are getting stuck in hospital, even once they are well. Our local hospitals provide great care, but older people, in particular, can suffer from the lack of activity a prolonged hospital stay brings. We have to address this and make it unacceptable. At the present time hospital pressures are often de-personalised through four-hour A&E targets, or financial control totals and referral to treatment times. We are at risk of losing the moral purpose behind effective care and must make sure this is central in our thinking and our plans.
Perhaps alongside the financial tariff, we should have a ‘value tariff’, a measure by which we identify when the value of hospital care has run out. At this point we know that care is moving from beneficial to potentially harmful. The urgency to address this should fall in to place at this time.
Similarly, people dying younger than they should, on a daily basis, is invisible to us. The statistic isn’t, but the sad reality of families losing loved ones is largely missing from our thoughts (I would argue) when we are busy in the thick of public sector work. Our staff see it, but I think as leaders we can (and I include myself) become immune to the reality that families are losing mums and dads, grandparents and friends sooner than is fair. In some parts of Manchester the difference is several years. Imagine what you could do with several more years of time with a loved one.
So to improve health and care in Manchester we need big goals; big goals on health improvement and big goals on changing how care is delivered across the whole care spectrum.
The good news is that the Manchester prospectus I mentioned earlier does contain the scale of ambition we need, we just have to turn that into big goals and develop a plan to show how we will make things different and better.
In the short term we have some key deliverables for 2018/19, it is critical we show value from very early on with the new MCO. At the same time (and we have started already, along with partners, workers and people in Manchester) we need to build the bigger plan to have a Local Care Organisation that helps Manchester transform its care for decades ahead.
Finally, my closing thought relates to the NHS 70th Birthday. I am very proud to have been a part of the NHS for 34 years, since starting as a student nurse in 1984. I am proud of the NHS and the UK health system. However, as with all birthdays, they are part celebration and part deciding on what you need to sort out or get in better shape - and the NHS isn’t in the best shape I have known it in those 34 years. So my plea on its 70th Birthday is that it is open minded, prepared to change and actively supporting new organisations like Manchester LCO that are uniting health and social care. After all, there isn’t a plan B.