Public Service Reform and the Public’s Health 1

PSR Strategic Overview Ambition is for sustainable economic growth, where all residents contribute to and benefit from sustained prosperity. This is set out in the GMS and our Growth and Reform Plan. Generating growth and jobs will not be sufficient to close the gap between tax and public spending. Reform public services to connect our people and neighbourhoods to growth. 2

Reform has to become a key mainstream element of how districts and partners will meet the financial challenges of 2015/16 and beyond. 2014/15 – two big ticket proposals to significantly scale up reform:  Complex dependency – broader and deeper than Troubled Families  Health and social care integration – investing in integrated care at scale 3

Ambition to be Financially Self-Sufficient GM spends around £5bn more than our total tax contribution Total tax take estimated at £17bn. Significant investment in growth. GM economy more resilient than most Need to sustainably reduce £22bn public spending Total spend has not changed in real terms, despite the cuts Proportions have changed – more on welfare benefits: costs of failure Work and skills is the key issue for both growth and reform; productivity, dependency and public spending 22bn 17bn £22.9 bn £22.5 bn 4

Reform and Growth PSR principles 1. Interventions chosen on strength of evidence base 2. Integrated and sequenced – bespoke packages of support – right time and order 3. Family based approach not just focusing on an individual 4.New investment models – partners investing across boundaries GM vision to pioneer a new model for sustainable economic growth, based around a more connected, talented, and greener city region where all our residents are able to contribute to and benefit from sustained prosperity. GM PSR Programme is central to the delivery of this vision. Increasing independence and enabling people and their families to take advantage of economic growth across the wider city region. PSR is how GM will reduce demand and dependency on public services by putting in place evidence based activity that reduces dependency, enables greater productivity and economic growth. 5

Reform Timescales 2015/16 to 2020 Investment agreements operational for all PSR themes Fully implement PSR across GM Aim to have GM deal on growth and reform with the next Government over a full spending period 2014/15 – March 2015 Testing PSR at greater scale Obtain strong evaluation evidence of actuals, to replace modelled assumptions Second version Investable Propositions that convince partners to invest at scale, and Government to do a GM deal October 2013 Develop best examples of Investable Propositions Submit GM Growth and Reform Plan for deal with Government, and ESF £ Autumn 2013 – March 2014 Commit to testing PSR at greater scale over next 18 months to generate strongest possible evidence End March 2014 Submit Health and Social Care pooled budget plans ESF round starts October 2013March 2014 April 2014April

Physical Activity and Public Service Reform Need to target public health interventions and bend the focus of mainstream services to stem the flow of demand. There is now better understanding that physical inactivity is a risk factor for ill health - and future dependency on public services. Some recognition that all agencies need to take action to reduce inactivity to reduce future demand on public services. However, physical activity is not regularly included in mainstream activities and many agencies are not clear what cost benefits are associated with increased physical activity. 7

Evidence base is available – and well developed in some areas – but not routinely applied by services. Return on investment tool has been developed but it measures benefits for health services (NHS) not all other agencies. More work to ensure that physical activity is reframed – as an evidence based intervention to reduce demand on public services… 8

Cycling: Societal Benefits Older people (50+) who engage in regular physical activity reduce their risk of dementia by 40%. (Dementia related services cost local government and the NHS over £19 billion a year) Mental health – condition management is better and recovery for longer for patients that undertake regular exercise (cycling is specifically mentioned). The LSE Report - The British Cycling Economy: Gross cycling product (potential growth for Greater Manchester) of £230 per cyclist. Frequent and Regular cyclists could save the economy £2 billion across ten years in reduced absenteeism Latent demand for cycling could amount to around £516 million of untapped economic potential for UK 9

Cycling and Public Sector Reform Need to raise awareness of what the future costs to public service agencies will be for a population that do not exercise regularly. Translate the physical activity language to one that is relevant for adult social care, children’s services etc. Be clear about how cycling can be built into other community activities or services. 10

Think about how the conversation moves on from 20 mph schemes (important but not everything) – to exercise becoming part of case management with complex individuals. Help agencies understand that investment in cycling is more than capital schemes. Working with community asset building programmes to develop community infrastructure to help people get on their bikes, keep their bikes working and stay safe. 11