Manchester city united in its devolution drive

Council leader Sir Richard Leese discusses the city's DevoManc devolution plans, the tight deadlines for delivery and the likely impact on procurement and the local digital economy
 
Manchester City Council leader Sir Richard Leese has discussed the city's role as a technology hub, how the devolution may impact procurement, and how Sir Richard and his team are already having to meet tight deadlines this year to meet its goal of achieving full devolution of health and care services by April 2016.

In an interview with Government Computing Sir Richard indicated that the clock is already ticking loudly for the council as it attempts to deliver its business plan to Whitehall.
"Well for health and social care, we need to have probably the draft business plan which has got to be the basis of negotiations with the government about the financial settlement going forward, by the end of September. It's got to be integrated with the Comprehensive Spending Review, so a lot of the work, the analysis work, the underpinning work, has to be done within those sorts of timescales."

Sir Richard last month opened IP EXPO Manchester a trade event intended to highlight the North West region's technological expertise and contribution to the UK's digital economy. The event, which highlighted the local interest in IT and digital infrastructure in the North-West region, attracted around 3500 visitors, and a similar event will take place in London on 7-8 October.
Sir Richard said the challenge of delivering devolution for Greater Manchester is something the council has been campaigning on "for a very, very long time."

He added, "Clearly we are doing things that haven't been done anywhere else in the UK. So there is almost an element of we're having to make it up because nobody else has done it before. Building the capacity to be able to do that is clearly an enormous challenge and we're also doing it in relatively short timescales.

"The health and social care integration, which is due to be, if everything goes well, onstream by April next year.. well, that's a phenomenally tight timescale. Talking about digital industries, again something I talked about at IP EXPO, the businesses themselves but then the extent to which we need improved ICT to underpin the sort of public service reforms we are going through within the city region, the need is going to be nowhere greater than we're going to find in the health and social care sector. Absolutely core to that is the ability to share data and that does mean having comprehensive systems that are capable of talking to each other quickly and reliably."

Speaking on growing the city as a technology hub, Sir Richard said the local Greater Manchester region had "enormous strength" in creative industries, and a "growing strength" in computing and digital industries.
"Both of those have above average growth rates even through the recession. What we need to do is build the infrastructure and in my view what the UK is particularly poor at in terms of digital infrastructure. This is an industrial sector where above all else, it will be skills that drive growth in order to maintain the growth within the city. We need to build the networks - there are a very, very large number of small companies that are in this space that build the networks that allow us to get the digital industries economy, an innovation economy where growth fuels growth.

"The devolution is part of how we deliver on this and clearly a very large element of devolution is having greater control over publicly funded skills within the city region and part of that is to have publicly funded skills bearing a closer correlation to present and future needs of the economy. Apprenticeships are included within that and clearly that does give us some opportunity to put a greater emphasis on computing skills, on coding, on the things that are needed to drive the digital industries.

Asked which organisations, such as the local Academic Health Science Network might take a proactive role in delivering health and social care, Sir Richard indicated that the route Greater Manchester is taking has the main providers as partners in the process rather than simply being the recipients of commissions.

"I think it's complimentary to what Manchester Adult Social Care (MASC) is doing in that the ultimate aim there is to take health innovation and that's more likely to be treatments and drugs and take them all the way through from on the ground identification through clinical testing right through to being able to get them into a place where they become saleable.

"Now that isn't the core of what we want to be able to do through integrating health and social care, but it is entirely complimentary and it's also entirely complimentary to...we're only going to be able to meet ever-growing demand by finding new and innovative ways of being able to not just treat people but more importantly, get to people before they need treatment. To get to people before they need treatment clearly does need a massive improvement in the communications we have both ways with people within our communities."

With other regions also considering devolution plans - West Midlands, for example recently brought Solihull and Coventry into its plans - Sir Richard outlined the lessons he had learned that other regions should bear in mind.

"The approach we're going down requires a lot of different public sector agencies, a lot of geographies, a lot of professions all working together on a way we've never working together before. So it has to be underpinned by relationships, and relationships at every level. The only way you can do this is by people spending an awful lot of time talking to each other, building relationships, building trust, building confidence."

But he stressed, that trust doesn't happen in a hurry. It takes time to happen.
"But there are aspects of the relationship building. For example, between the local authorities, which is what we've been doing for getting on for three decades now. This was not an overnight success. If we hadn't put the effort in to building those relationships, it wouldn't have got here. I mentioned geographies; I didn't mention cross political parties as well, because Greater Manchester has been developing its arrangements on an all party basis as well."

Sir Richard was cautious when asked whether there is likely to be a net saving in Manchester when the public service work is unified, with back office and procurement done more cheaply, or conversely, whether the area might instead be one for investment.
"From the local authority perspective," he said, "the improvements in efficiency over both back office and procurement mean that the scope for significant savings is quite small and it may be that within the health sector that we're able to generate savings, although put that against the demand equation and it will only make - even if we get significant savings related to both budgets - it will only make a small dent in the overall demand for expenditure. Where I think there is rather more to be looked at is where we can make a case for upfront investment that gives downstream savings particularly the downstream savings that reduce admissions to hospital and speed up release from hospital."

Sir Richard was asked whether, if integrated health and social care is one of the areas where IT is going to be needed to support new initiatives, whether he had any views on what is currently missing and how the assets that are developed or procured to support Manchester are going to feel different from those that are being developed by the vanguards in other areas of the UK where health and social care are being conceived of together.

He argued that the UK is "going on a journey of integrated health and social care, so every part of the country is going to be doing it," adding, "...the big difference is going to be the speed and the comprehensiveness. The proposals for Greater Manchester are both more comprehensive and faster than what's happening elsewhere but we are all going to be facing the same issues. For me there are a few things around what we need.
"First of all, we have some of the core systems that we're using that don't appear to be wholly fit for purpose. So for example, the MiCARE system which is clearly a quasi nationally based system doesn't appear to have the functionality that we really need. It's having the base systems right. It is the ability for systems to communicate, which in this day and age shouldn't be that complicated. Probably the most complex bit of this is not the bit to do with the technology at all, it's going to do with the protocols that allow people to do that sharing."

Given the short-timespans that Manchester has to achieve its health and social care target next year, does he see a potential for brand new systems to be developed perhaps using some of the technology firms within the region and for a new approach to IT?
Sir Richard said, "Caveat this with the fact that I'm not a technology expert, but experience over the last few years suggested that adapting existing systems including some development of those is going to be the root to achieving what we want rather than staring scratch designing new systems. Not least, we haven't got time to either design them or thoroughly test them. I think over time, clearly systems will become obsolete. There are going to be new products that come onto the market. But that's not going to get us through the next couple of years."

Sir Richard was asked whether, in terms of Manchester's business plans, whether back office and procurement activity would provide a net saving - i.e. that back office and procurement should be done more cheaply when the public service work in Manchester is unified. Or whether the impact is going to be neutral or whether an increased level of spend would be acceptable. In other words, is this an area for savings - or investment?

"From the local authority perspective," said Sir Richard, "the improvements in efficiency over both back office and procurement mean that the scope for significant savings is quite small and it may be that within the health sector that we're able to generate savings, although put that against the demand equation and it will only make small dent in the overall demand for expenditure. Where I think there is rather more to be looked at is where we can make a case for upfront investment that gives downstream savings particularly the downstream savings that reduce admissions to hospital and speed up release from hospital.

"I think we have two things going for us in terms of health and social care. The first is we've basically got every aspect of provision in the tent - we've got primary community, acute services and care services all in the tent. So we can look at provision within the round. But also I think that Greater Manchester has sufficient scale to be able to take on every aspect of those services. I think it's a combination of comprehensiveness and being the right scale gives us real opportunities in that area."

The prevailing view across government is that when it comes to developing services, the way to do so is now to experiment, to have pilots and use limited rollouts of things that will change the dynamic for service users. So where does Leese stand on the distinction between getting it right and rolling it out for everybody - or being able to experiment and fail fast?

"I think we need to get the right mix between innovation and evidence-based approaches," he said. "And clearly, if things aren't working effectively at the moment then you have to try and do something new. So there has to be innovation. But you have to then build an evidence base around that, around whether it's working, why it's working, before you can start expanding that. That innovation work, that pilot work, that experiment work, has been going on across Greater Manchester now for certainly a good three years. That means we have built an evidence base and on the basis of that evidence base we can attempt to take what we're now doing in Greater Manchester up to scale.

"I think in terms of general applicability, yes, we want the best for everybody. But if Greater Manchester is sufficiently successful in doing what we're doing, then that will provide a model that other places can use. I think that's the right route rather than making unevidenced assumptions about what might work and just applying them all over the place and taking a punt."

Discussing procurement further, Sir Richard gave his views on linking procurement to investment in Manchester, the skills agenda in the city, and companies having business activities in your region.
He said, "I think there has been an increasing trend in all procurement to relate it to local employment, skills development and so on and I think that will undoubtedly be the case about what we are doing now. Again, my experience..procurement of IT services is really, really difficult in the sense that where you have very, very rapidly changing technologies, it is very easy to get locked into contracts that keep you stuck and you end up five to seven years behind the game by the time you get out of there.

"So one of the things we'll be looking for in procurement, and particularly IT procurement is to have the right balanced between in-house and external providers that allows us to develop our IT at the same rate as developing new ways of delivering services. I don't think, from previous experience that is necessarily going to be particularly easy.