GREATER MANCHESTER COMBINED AUTHORITY (GMCA) EVIDENCE – WRITTEN EVIDENCE (PSR0017)
KEY MESSAGES Greater Manchester (GM) has a long history of strong, integrated partnership working across services. Throughout the crisis, GM has worked closely with Government to support and develop the response to the pandemic. The Government response has, in many ways, been commendable, however there are lessons to learn. Greater openness and improved communication would make co-ordination of services with Government more straightforward in future emergencies. A regional voice on COBRA could support this. Place-based delivery is central to GM’s view of public service reform. This crisis has allowed us to accelerate our plans and build on our existing approach to support many thousands of vulnerable and shielding people across the city region. GM’s established leadership and arrangements for collaboration were important factors in the emergency response. The GM Civil Contingencies and Resilience Unit played a key role in the city region’s preparedness for the crisis, The pandemic has provided an opportunity for GM to accelerate its public service reform activity in some areas. Much of this work, including the establishment of community hubs, will be retained and strengthened going forward. Integrated commissioning has allowed GM to respond to the crisis in innovative ways and bring public services together. GM’s PPE taskforce has helped ensure the city region is supplied with vital equipment when national procurement was struggling to meet demand. The ‘Everyone In’ scheme has been very successful locally, but Government funding is needed to support all rough sleepers and those at risk of homelessness. Local authorities will need financial assurances in order to promote a sustainable economic recovery. Long-term funding is also needed to support GM’s public transport system. GM’s sizable VCSE sector played a key role in the emergency response to CONTENTSCOVID-19 and worked hand in hand with public sector services to support (I)residents.Introduction (II)GM hasCo-ordination utilised this of opportunityPublic Services to accelerate with Central existing Government public health strategies (III)to mitigatePlace-Based some Delivery impacts of COVID-19 and reduce demands on local health (IV)services.Greater Manchester’s Preparedness (V)GM isNew cognisant Ways of of Working the significant impact that this crisis has had on some (VI)communitiesIntegrated and Commissioning tackling inequalities will form a key strand of the city region’s (VII)workFinancial to ‘build Support back better’. for Local GM Governmenthas also put in place a number of immediate (VIII)supportRole servicesof the VCSE for vulnerable Sector groups in this period. (IX) Preventative Public Health Strategies (X) Meeting the Needs of Vulnerable Groups (I) INTRODUCTION
Throughout the COVID-19 pandemic, the Greater Manchester Combined Authority (GMCA) has worked hand in hand with Greater Manchester’s ten local authorities, our health & care organisations and VCSE sector, as well as Greater Manchester Police (GMP) and Transport for Greater Manchester (TfGM) to provide public services that help support local residents and businesses through this unprecedented time of crisis.
Greater Manchester’s devolution journey began over thirty years ago in the aftermath of the abolition of the metropolitan county councils. The ten local authorities in Greater Manchester saw the value of continued close collaboration across the conurbation and, over the following years, worked together on a number of key strategic priorities for the city region, including attracting inward investment and tourism to the area and the development of our light rail system, Metrolink.
In 2009, an independent economic review of Greater Manchester highlighted the possibilities for strengthened collaboration between the local authorities, which led, in 2011, to the creation of the Greater Manchester Combined Authority (GMCA), a legal body with significant powers of its own.
Over the following years, a number of devolution agreements were signed between Government and the GMCA, bringing new powers and responsibilities to the region, including over transport, further education, and health and social care. In order to deliver these devolution agreements, it was decided that Greater Manchester should have an elected mayor to act as a single point of accountability for the region and a powerful voice for its people.
Today, Greater Manchester continues to work together to improve the lives of all its residents, whilst maintaining the unique identities and autonomy of its constituent parts.
Place is at the heart of the GMCA’s proposition for Greater Manchester (GM) and this focus, woven through our approach to public services has allowed us to respond to COVID-19 from neighbourhood through to city regional level, both politically and non-politically. Throughout the pandemic, we have engaged all MPs in the city region and sought to involve them in our work.
This evolutionary development and clear focus has given GM strong, cross-party leadership and structures that have enabled us to react to this crisis and develop collaborative responses to the pandemic at pace.
As we reach the end of this period of lockdown, now is an opportunity to reflect on the lessons learnt through our response to the crisis. This learning is an ongoing process and, in Greater Manchester, we are constantly adapting and revising our approaches, based on our experiences. Nonetheless, a small number of key lessons are already apparent: Locally driven processes and responses are more effective than those prescribed centrally through ‘top-down’ approaches and enable improved co- ordination and collaboration between agencies. Relaxation of Government requirements and increased local control have allowed us to work more efficiently and effectively, bringing forward new tools (e.g. digitalised records) that have increased productivity.
England’s localities have an integral role to play to support both the immediate response and the subsequent period of recovery that will follow over the coming months and years. The crisis has added greater urgency for further devolution of powers and funding to local and city-region authorities. Localities are at the front line of this crisis and are uniquely situated to bring together businesses, the voluntary sector and public sector bodies to respond to the social and economic impacts of COVID-19.
(II) CO-ORDINATION OF PUBLIC SERVICES WITH CENTRAL GOVERNMENT
Questions addressed: How well did central and local government, and national and local services, work together to coordinate public services during the outbreak? For example, how effectively have national and local agencies shared data? How effectively have different public services shared data during the outbreak?
Greater Manchester has worked closely with Government to protect and support the public throughout the COVID-19 pandemic.
Whilst some aspects of the Government’s response to COVID-19 have undoubtedly been commendable, the centralised nature of some elements has, in some cases, significantly impeded effective collaboration and communication with local authorities. The Mayor of Greater Manchester has stated on numerous occasions his desire for a regional voice to be represented on the Government’s COBRA committee, which we believe would help to ameliorate some of these issues.
The communication that has been possible has been helpful: GM has appreciated the level of ministerial engagement throughout this period and we have found both the regular Economic Recovery Working Group meetings and the Greater Manchester Ministerial Stocktake to be useful forums for the sharing of issues, blockages and opportunities to support the city region’s recovery.
Local authorities in Greater Manchester have played a fundamental role in supporting the economic response to the crisis. The programme of £10,000 support grants for small businesses was initiated and funded by Government but local authorities were responsible for their distribution, requiring a significant degree of coordination between localities. We are grateful that Government took on board Greater Manchester’s concerns about support for businesses that do not pay business rates directly and introduced an element of discretion in the scheme for local authorities to use. GM has worked closely with Government to secure two funding packages to support the continued operation of Metrolink in the short term. On 23 May, the Transport Secretary confirmed £13.3million in funding to support Metrolink services until August. This followed earlier confirmation from the Department of an initial 12-week funding package equating to 73% of GM’s ask, to contribute to running Metrolink to early June. This latest funding from Government is welcome and will help Metrolink increase frequency closer to pre COVID-19 levels, albeit with limited capacity due to social distancing. It demonstrates that central Government acknowledges the significance of Metrolink to GM and the package is the outcome of an effective working relationship. However, the short-term nature of these funding deals is a challenge and Greater Manchester is keen to continue to work closely with Government towards a sustainable funding solution to allow the city-region to plan for the longer term.
The successful delivery of the National Shielding Programme has also required significant co-ordination of public services between localities to ensure our most vulnerable residents receive the support they need whilst isolated from wider society. The programme has seen many successes and, in GM alone, thousands of shielding households have received food, medicines and other vital supplies on a weekly basis. Nonetheless, improved communications and increased openness at a national level would have made the handover between the national helpline and local authorities more straightforward and possibly remove the need for local authorities to step in urgently where residents had fallen through gaps in the process. The need for improved dialogue with local Government must be a clear lesson for Government as we emerge from this crisis.
GM’s interactions with Public Health England (PHE) around the COVID-19 pandemic have been positive, although most of the data available to Local Authorities and Combined Authorities is still only based on Pillar 1 testing, i.e. those tests carried out in PHE or NHS labs. This data misses out the commercial testing (Pillar 2), which includes the large operations at the Etihad Campus and Manchester Airport. Based on the UK figures it is estimated that about a third of positive tests relate to the Pillar 2 testing; without the Pillar 2 testing data it is therefore not possible to get a full picture of infection rates.
Very recently, GM has begun to receive an output from PHE North West which includes the Pillar 2 data, and breaks this down to MSOA level (geographies with, on average, around 7000 population). This is in map form with tables of the top 5% of MSOAs for GM that week. We have also worked with PHE to provide GM with the data aggregated to our neighbourhood areas, which generally have populations of between 30,000 and 50,000. We are currently discussing with PHE how we might access its raw data feed, giving us the detailed information that we need to manage the disease and deal with any local outbreaks that may occur over the coming months.
(III) PLACE-BASED DELIVERY
Questions addressed: Can you provide any examples of how public services worked effectively with a local community to meet the unique needs of the people in the area (i.e. taking a “place-based approach” to delivering services) during the COVID-19 outbreak? Were some local areas, where services were well integrated before the crisis, better able to respond to the outbreak than areas where integration was less developed? Can you provide examples?
Our commitment to place-based delivery is central to Greater Manchester’s public service reform philosophy. Frontline public servants, in partnership with voluntary and community organisations, working with and as closely as possible to the residents they serve, has been one of our underlying principles for a number of years. In July last year, we published our white paper on unified public services for the people of Greater Manchester. This document sets out our approach to a 21st century public service system with people, prevention and place at its heart. The document describes the key features of this model as they are observed across GM’s local authority areas and we have been working to embed these further.
When the crisis hit, the key features of our place-based model provided a solid foundation for an immediate response. In particular, the existing integrated structures we already had at neighbourhood level – defined as areas with a population of 30,000-50,000 – enabled us to stand up the humanitarian assistance response with considerable pace and efficacy. The strength of existing place-based relationships and partnerships, in particular with voluntary and community groups, meant that the establishment of new neighbourhood services was more about adjusting how we were already working together rather than establishing a completely new way of working. This helped considerably with coordinating the humanitarian response and getting help to those who needed it most.
Our existing place-based and integrated approach also meant that much of our organisational infrastructure was already joined up and able to respond rapidly. Joint strategic leadership across local authorities and CCGs, pooled budget mechanisms and shared finance, IT and HR functions led to greater preparedness for the crisis.
Our place-based approach relies heavily on the knowledge that ‘it is people that make up places’. Being person-centred at the strategic level has meant that, in responding to the crisis, we have looked beyond just the clinical vulnerability resulting from the pandemic and have given an early and equal emphasis to the social vulnerabilities caused, or exacerbated, by COVID-19. As a result, community hubs in Greater Manchester were also providing weekly support to many thousands of households outside of the shielding cohort. ‘There’s a person behind every food parcel’ was a phrase coined early on in one of our community hubs to underline the fact that our public services were providing much more than a food delivery service to residents.
(IV) GREATER MANCHESTER’S PREPAREDNESS
Questions addressed: How well did central and local government, and national and local services, work together to coordinate public services during the outbreak? Were some local areas, where services were well integrated before the crisis, better able to respond to the outbreak than areas where integration was less developed? Can you provide examples? Would local communities benefit from public services focusing on prevention, as opposed to prioritising harm mitigation?
Over the last 30 years, Greater Manchester has benefitted from strong, well- established political and non-political leadership. Not only has this enabled the process of devolution in the city region to go further and faster than elsewhere, it has also enabled the city region to stand up the new ways of working demanded by this crisis at pace.
In 2010, Greater Manchester’s local authorities established the GM Civil Contingencies and Resilience Unit (CCRU) as a shared service for emergency planning, response and resilience building across the conurbation. The CCRU has a central role within the GM Local Resilience Forum (LRF), providing the secretariat function and co-coordinating local authority involvement in multi-agency activities, including those required under the Civil Contingencies Act 2004.
Through the CCRU and LRF arrangements, GM has developed strong partnership arrangements for emergency preparedness and resilience work which reflect GM’s long history of strong, integrated partnership working in public service delivery more generally. Joint emergency response arrangements have been tested repeatedly through a range of emergencies including terrorist attacks, flooding and major fires.
In 2014, GM joined the United Nations Making Cities Resilient Campaign and shortly after became an international ‘Role Model for Total Resilience’ by demonstrating a broad approach to building resilience to disasters. This encompasses activities required under the Civil Contingencies Act 2004 (which focus on preparing for emergency response) but also much broader work which recognises the need to also reduce the risk of disasters occurring as a priority.
Building on this, GM was subsequently successful in its bid to become one of the Rockefeller Foundation’s 100 Resilient Cities, reflecting GM’s commitment to an even broader agenda of building urban resilience. In particular, this includes:
recognising how global change (including globalisation, urbanisation, climate change and technological development) can amplify local risk understanding the relationship between shocks (civil emergencies such as outbreaks) and chronic stresses (issues which threaten to the fabric of society such as inequality and deprivation) adopting whole system, whole society approaches which recognise the complex interdependencies of risk and resilience issues
In practice, this has involved establishing a Chief Resilience Officer post (based within the Greater Manchester Combined Authority) with responsibility for leading GM’s resilience agenda, including through the development and implementation of the GM Resilience Strategy and by working to influence and share practices regionally, nationally and internationally. Ahead of COVID-19, GM’s approach to resilience building has supported work to address many of the chronic stresses which have been brought into sharp focus by the outbreak, including work to address poverty and homelessness, strengthen the economy, build community resilience, improve poor health outcomes and tackle climate change. The need to continue with these efforts is captured within the emerging GM COVID-19 Recovery Plan and will also remain central to GM’s resilience agenda in future.
Recognising that risk will not be fully eliminated, however, planning for emergency response will also remain a key priority. During COVID-19, existing arrangements for emergency preparedness and response enabled a rapid set-up of multi-agency command and control arrangements, with a good understanding of partnership strengths and responsibilities, including those across residents, businesses, the VCSE and all other sectors. This, combined with GM’s ability to innovate, has resulted in many positive aspects of the response - including establishment of community hubs and work with businesses to provide PPE. GM is now seeking to build upon these developments in order to improve resilience to future adverse events as part of its recovery work.
(V) NEW WAYS OF WORKING
Questions addressed: Has the delivery of public services changed as a result of coronavirus? For example, have any services adopted new methods of meeting people’s needs in response to the outbreak? What lessons can be learnt from innovation during coronavirus? Are there any examples of services collaborating in new and effective ways as a result of COVID-19? Are there lessons to be learnt for central Government and national regulators in supporting the integration of services?
As the scale of the crisis became apparent, Greater Manchester agencies quickly and flexibly mobilised their resources to support residents, businesses and vital public services. We are keen to learn and reflect on the innovation we have seen during the crisis to-date and have commenced a piece of work to proactively distil the learning so far and as it develops. We know that there are undoubtedly lessons for the new business-as-usual and future operating models. To support vulnerable and shielding residents during the crisis, all local authorities in GM have stood up community hubs at a neighbourhood level to provide food, medicines and support general wellbeing. This response validated new ways of working that were already emerging or apparent in Greater Manchester, for
Case Study – Community Hubs in Bury
A key part of Bury Council’s COVID-19 emergency response has been the establishment of five Community Hubs to provide the infrastructure to support vulnerable people. The initial priority was to support those who are classed as extremely clinically vulnerable (shielded) for a period of 12 weeks. The Hubs follow the footprint of the existing health and social care Integrated Neighbourhood Teams (INTs), with a remit to provide support for extremely vulnerable people who have no natural support from friends, family or neighbours with local volunteers to do shopping, collect medication and offer a befriending service. That remit has since expanded to the sub shielded group of socially vulnerable people who are self-isolating, are over 70 or need support from other services that the hubs can link them to e.g. food banks, welfare advice, community mental health support. A comprehensive operational model that flows from the Contact Centre to hubs to volunteers, supported by the corporate data team, has led to a seamless approach to emergency provision.
The Hubs will provide support any returning travellers to Bury who may need to be quarantined and to people who need to self-isolate as part of the Test, Track, Trace, Isolate Policy which may increase demand for the hubs’ services.
Each hub has a named lead officer - employees temporarily redeployed to the COVID-19 response. Alongside the lead are a number of other staff from non-priority 1 services who have also been temporarily redeployed. A total of 150 staff have been temporarily redeployed to the hubs. Contact with the hubs is through a central number, 9am-5pm seven days a week. Outside of these hours, calls are monitored by the Council’s Emergency Control Room.
At the time of writing, the Community Hubs have: received over 2462 calls; provided direct support to 1487 residents of which 788 received shielded support engaged more than 800 volunteers providing support to vulnerable people dealt with over 1650 food shopping and medication collection tasks by volunteers distributed in excess of 440 emergency food parcels via Porchbox.
Community Hubs have been rolled out across all GM local authority areas. Hubs in other areas have seen similar or higher levels of demand compared to those in Bury. example, organisations working across shared neighbourhood footprints, distributed leadership arrangements and seeing VCSE organisations as equal partners.
The response to the crisis and the rapid development of new public services has led to a number of staff being redeployed from their ‘day jobs’ to provide the additional support required. The fluidity with which staff were redeployed and the transferability of existing skill sets has highlighted opportunities around re-thinking future workforce development.
At both a local and city region level, we have witnessed strong participation from the private sector, particularly in the humanitarian response: GM has received significant donations of personal protective equipment, food and accommodation from businesses in the city region. Understanding how we can best harness the totality of this good will and commitment will be an important part of our socio-economic recovery.
New practices have also been put in place to support the health and care response to COVID-19. Our unique health devolution arrangements give us the flexibility to introduce bespoke interventions to support the health of our residents and we anticipated that these tools will be maintained and improved throughout the pandemic and beyond.
In just 7 weeks, health and care organisations across Greater Manchester deployed the GM Care Record for all 2.8 million residents of the city region. The Record collates information held by different health and care organisations to ensure that clinicians can see up-to-date medical records, care plans, medications and test results to inform the right care and treatment. The GM Care Record also includes information about when a patient has been tested or diagnosed with COVID- 19 to ensure continuity of care across different settings.
We have also been able to develop a system that supports care homes across Greater Manchester to track and report COVID-19 symptoms in their residents. This has allowed the health and care system at large to better understand the situation in care homes across the city region and make the right strategic decisions at pace.
Greater Manchester has also seen the value of broader stakeholder engagement. Our Communications and Engagement Cell, bringing together communications leads from across the conurbation, has been vital in supporting partnership working and promoting a consistent GM message.
(VI) INTEGRATED COMMISSIONING
Questions addressed: Were some local areas, where services were well integrated before the crisis, better able to respond to the outbreak than areas where integration was less developed? Can you provide examples? Are there any examples of services collaborating in new and effective ways as a result of COVID-19? Are there lessons to be learnt for central Government and national regulators in supporting the integration of services? In GM, we have a whole public service approach to commissioning. In health and care, each of the 10 localities has formed an integrated commissioning function between CCG and local authority – and several localities have a single chief officer for both organisations. This has led to the creation of significant pooled budgets at place level.
These commissioning arrangements facilitate a whole system population health perspective on spend and deployment of models of care and support. As such, they have proved to be a vital enabler of an integrated, place-based response to COVID- 19. Social Care is an integral part of governance at local and GM level and this has allowed a fully joined up approach within the city region. Our model of integrated commissioning has supported a number of vital interventions in this period of crisis.
As the pandemic unfolded, it quickly became apparent that the nationally-led efforts to provide public services with vital personal protective equipment (PPE) would be insufficient. To fill this gap, GM established a central procurement system for PPE for all public services in the city region, with direct procurement in national and international markets. Our PPE taskforce, made up of partners from the Combined Authority, MIDAS (Manchester’s inward investment agency with international business contacts), Growth Company, Health and Social Care Partnership and local authorities, has successfully coordinated PPE stocks for frontline services across the conurbation and international orders of additional equipment from the open market.
Through this coordination at city region level and working as one system, the taskforce has been able to share supplies amongst services in Greater Manchester through mutual aid to help those in greatest need on a day-to-day basis. For example, Wrightington, Wigan and Leigh NHS Trust secured PPE through mutual aid from Wigan Council, Wigan and Leigh College, Winstanley College, GMP and Stockport Council, as well as from wet wipe manufacturer, Nice-Pak International.
Integrated commissioning has also supported Greater Manchester’s homelessness response during this crisis. The Government’s ‘Everyone In’ programme has given us an opportunity to support around 1,500 rough sleepers during this period, although support is still needed to fully fund accommodation for all those sleeping rough or at imminent risk of rough sleeping.
To support the transition from this provision, the GMCA and Greater Manchester’s health and care system have jointly commissioned a third phase of the ‘A Bed Every Night’ scheme, which will deliver 445 beds across all 10 local authority areas. As this change takes place, we would like to work in partnership with Government to ensure the switch is made as effectively and sensitively as possible.
(VII) FINANCIAL SUPPORT FOR LOCAL GOVERNMENT
Questions addressed: Did resource problems or capacity issues limit the ability of public services to respond to the crisis? Are there lessons to be learnt from the pandemic on how resources can be better allocated and public service resilience improved?
The GMCA, ten local authorities and other public sector partners have taken considerable action to maintain fiscal sustainability throughout the coronavirus crisis and as a city-region, have responded well to the challenges that COVID-19 has presented and the new responsibilities that have been taken up at short timescales.
The funding received from Government to date has been welcome for both local government and our local economies. However, decisions taken by Government in the coming weeks will be critical as to whether authorities are able to pursue ‘healthy’, long-term recovery strategies or are forced to make damaging short-term financial decisions that jeopardise the longer term interests of residents and the authorities themselves. There are many areas of concern for local and city- region public finances beyond those outlined below and we will be engaging further with Government on these issues.
Certainty on the extent to which excess spending by councils on coronavirus measures will be covered by Government, and clarity on funding levels for 2021/22 and beyond will allow local government to optimise recovery strategies and may allow for a more aggressive approach to the spending of council reserves to support residents and local businesses. At present, the reserves held by local authorities are generally low after significant cuts over the past decade and many of these funds are allocated for specific purposes or risks identified pre-COVID-19. Many of our local authorities have taken decisive and necessary action, making the decision to draw on these reserves with no formal guarantee from Government of their replenishment. We therefore urge Government to make this commitment to replenish these reserves as soon as possible.
The risk to local authorities of being forced to issue Section 114 notices under the Local Government Finance Act 1998 should not be underestimated. This would occur if they are unable to balance budgets as a result of coronavirus response spending and would result in our local authorities being unable to enter into any agreements occurring further expenditure. This could be disastrous in the event of a second peak of the virus and will also significantly undermine efforts to develop an adequate recovery strategy to ‘reboot’ the economy. The upcoming Spending Review will be important in determining the future needs and resource envelope for local government. However, given the severity of the position we are in, we cannot wait until the Finance Settlement in December to understand what resources will be available for 2021/22.
Local authorities are not seeking a wholesale debt write off in the same way that the NHS has received. However, there must be a support package in place that fully covers the financial costs associated with COVID-19 which reflects the loss of commercial, regulatory and finance fees and charges income. The support must also leave an adequate level of reserves to retain resilience to plan over the timeframe of the economic recovery and to deal with any future shocks.
Based on current projections, the financial impact of this crisis on local government in Greater Manchester in 2020/21 is expected to total £732m. To-date, Government has announced funding of £272m for local government in the area.
The impact of these financial losses after the long period of austerity will, without further funding and other flexibilities, leave councils facing huge financial challenges. These challenges come at a time when councils and public services have a critical role to play in supporting the recovery from COVID-19 and helping the region to build back better. Some of the measures that would assist with the financial position of local authorities include:
. Providing certainty for planning: Confirming a further roll forward of core funding and grants for 2021/22 to provide a basis on which authorities can plan, given Fairer Funding and Business Rates reforms have been deferred. . Protecting our resource base (Business Rates and Council Tax): Business Rates bases will contract further with an increasing number of businesses likely to go into liquidation, increases in bad debt and a growing number of appeals and claims for relief. Council Tax revenue faces the combined impact of: increasing numbers of people requiring Council Tax Support; a reduction in collection rates; and a slow-down/reversal of growth in the council tax base. Consideration should be given to how cash flow support for the Collection Fund position could be provided until the position recovers. . Recognition of new burdens: There will be additional responsibilities such as sustaining resilience measures, contact tracing and PPE and increasing costs in areas such as Social Care and homelessness that will continue beyond the lockdown period, including the need to stabilise the care market. These will require funding. . Commitment to the roll out of the UK Shared Prosperity Fund: Recognising the needs of city regions and other localities and considering wider investment packages that would support developing public transport infrastructure and recyclable investment funds. . Measures to sustain local authority capital investment and economic recovery planning where we would be happy to provide more detail. . A well-informed and frank discussion between central and local government about the financial platforms needed for effective service delivery going forward: This should avoid funding relationships with Government that result in frequent ‘cliff edges’ and prevent long-term planning.
A key live area of concern for Greater Manchester’s public finances is related to the provision of a sustainable, long-term financial support package for the city- region’s public transport system. For our economy to bounce back as swiftly as possible, Government needs to bring forward a long-term, sustainable funding package for both Metrolink and buses that is less tied to fare box revenue to allow the services to continue operations during and after the remainder of the COVID-19 crisis. Government funding should give conditionality that affords public authorities a degree of control over bus operations to ensure that the combined Metrolink-bus system can provide optimal support to keep the city-region moving through this period.
(VIII) ROLE OF THE VCSE SECTOR
Questions addressed: What lessons might be learnt about the role of charities, volunteers and the community sector from the crisis? Can you provide examples of public services collaborating in new ways with the voluntary sector during lockdown? How could the sectors be better integrated into local systems going forward? Greater Manchester’s VCSE sector has played a critical role in the response to this crisis, operating in close alignment with public sector services. GM is home to nearly 16,000 voluntary organisations, community groups and social enterprises working to tackle inequalities and improve the lives of local people. This ‘sector’ is extremely complex and made up of a wide range of organisations including: Small, community-led organisations with an annual turnover of less than £10k and are driven by the passion of volunteers to help others (these make up ~70% of the sector) A network of specialist charity service providers, trading charities and social enterprises A network of infrastructure organisations acting as ‘anchors’ in and for communities, neighbourhoods, localities and at a GM level A number of large, national charities with a local presence.
The VCSE response to the COVID-19 emergency across GM has been incredible in its strength, its depth and the speed at which it has been mobilised. VCSE organisations of all sizes, as well as community volunteers, are offering their support and are integrating with emergency support structures at this time. The sector has been quick to adapt at pace and with a huge degree of accuracy and efficacy to meet the needs of GM communities. Early feedback shows that around two thirds of VCSE organisations have had to change the way that they work in the current crisis. VCSE organisations are: Providing frontline services - Many VCSE organisations have increased capacity in their services, working with the most vulnerable and isolated in our society and across the full breadth of our diverse communities in GM. Supporting people and communities in the most vulnerable situations. VCSE organisations have been especially key in providing this frontline support to people and groups in the most vulnerable situations. Supporting sector-wide collaboration, coordination and leadership. VCSE infrastructure organisations (10GM, GMCVO and others) have expanded and reorganised the scope of their work to support the frontline response.
(IX) PREVENTATIVE PUBLIC HEALTH STRATEGIES Questions addressed: Would local communities benefit from public services focusing on prevention, as opposed to prioritising harm mitigation? Were some local areas able to reduce harm during coronavirus by having prevention-focused public health strategies in place, for example on obesity, substance abuse or mental health?
Greater Manchester has put in place and accelerated a number of preventative public health strategies during the COVID-19 pandemic. As we move into a recovery phase, these strategies will remain of significant importance, particularly in mitigating the impacts of a ‘second wave’ of the disease and protecting the city region’s health infrastructure.
The Greater Manchester Health and Social Care Partnership (GMHSCP) aims to end an intergenerational cycle of smoking by reducing rates by one third in less than four years and ultimately making smoking history in the region by 2027, ahead of the UK Government’s ambition for England to be smoke-free by 2030.
In July 2017, the GMHSCP introduced a comprehensive tobacco strategy, Making Smoking History, A Tobacco-Free Greater Manchester 2017-2021. It has been delivered at a significant pace and scale and with overwhelming public support from 8 in 10 residents, including half of all smokers, which has supported smoking prevalence falling twice as fast in Greater Manchester compared to England. For adult smokers the longstanding gap with England is closing and the number of never-smokers has increased; fewer young people are starting to smoke. The latest Smoking Toolkit Study (STS) data suggests GM’s prevalence is 13%. The strategy’s achievements to date indicate Greater Manchester is on track to meet its bold ambitions.
During the COVID-19 pandemic, the programme has continued, with modifications due to lockdown and social distancing, and to take advantage of opportunities to engage at scale with rough sleepers as part of humanitarian support efforts. The programme’s focus has been on supporting smokers to attempt to quit given emergent evidence of a link between smoking and more severe COVID-19 illness and outcomes for smokers. GM has linked with national partners through the Smokefree Action Coalition and with PHE and NHSE to ensure a focus on our most vulnerable smokers in GM and nationally.
Smoking is the single risk factor linked to all non-communicable disease COVID-19 risk factors: cardiovascular diseases, diabetes, chronic respiratory diseases and cancer. The pandemic is both exposing and exacerbating existing inequalities in health and the social determinants of health. Smoking is among the leading causes of health inequality, early death and disability in the city region as a result of differences in social, economic, environmental and commercial determinants impacting from conception through every stage in the life course.
GM localities have moved quickly to shift delivery mechanisms for stop smoking services to virtual channels and, through the Making Smoking History Programme, additional support capacity has been commissioned via the Smoke Free Pro App, the only stop smoking app that follows NICE guidance for smoking cessation. GM has also acted to seize this window of opportunity when smokers are more responsive to quit messages by launching additional digital and social media campaigns to reinforce existing messaging, make smokers aware of their increased risk of COVID- 19 and encourage quit attempts. The campaign aligned with the national #QuitforCOVID campaign that has featured in the media and on social media, and gained support and recognition from PHE.
A significant focus of activity has been supporting rough sleepers to switch from smoking to vaping as part of humanitarian response by providing 800 e-cig kits plus support to around 1,000 rough sleepers in emergency accommodation, plus domestic violence refuges. This harm reduction response has moved residents from smoking to vaping to reduce infection and fire risks and smoking harms. It has been positively received by residents and staff.
GM’s successful Smokefree Pregnancy Programme has adapted to deliver business as usual. While personalised carbon monoxide (CO) screening is paused nationally, GM is the only area in the country to date to have purchase personalised CO monitors for pregnant women to allow maternity services to support women to quit and remain smoke free throughout their pregnancy. GM’s CO validated quit rate for women who quit smoking with support during pregnancy is twice the national average at 55% v 26%. Over 50% of partners quit smoking and 84% report making their home smoke free.
Another example of a preventative strategy activated at this time has been the increased distribution of naloxone in order to reduce the potential number and impact of drug-related overdoses (and deaths) on NHS hospital resources. Naloxone is an emergency antidote for overdoses caused by heroin and other opiates/opioids (such as methadone, morphine and fentanyl). The main life-threatening effect of heroin and other opiates is to slow down and stop breathing; naloxone blocks this effect and reverses breathing difficulties, improving outcomes for drug users and reducing demands on hospitals.
(X) MEETING THE NEEDS OF VULNERABLE GROUPS
Questions addressed: Have public services been effective in identifying and meeting the needs of vulnerable groups during the COVID-19 outbreak? Are there lessons to be learnt for reducing inequalities from the new approaches adopted by services during the COVID-19 outbreak?
There is a growing body of evidence that the worst effects of the COVID-19 pandemic have traced and amplified pre-existing patterns of inequality in our communities. As Greater Manchester moves into recovery and renewal, that recovery must ensure that it is inclusive and aims to address structural inequalities, limits the long term negative effects of the pandemic and strengthens the resilience of GM. This goes beyond the equalities agenda as set out in the Equality Act, and should include groups of citizens now facing poverty, poor health and wellbeing, and struggling to retain or secure employment, for example. During the crisis, Greater Manchester agencies and the VCSE sector have moved quickly to support our city region’s most vulnerable communities, including people whose first language is not English, homeless people, people on low incomes and people who were not already in contact with public services.
In these difficult times, it has been extremely important for young people to maintain contact with their schools and colleges. To support disadvantaged and digitally excluded pupils, the GMCA has invested £150,000 in 567 digital kit bundles, including a laptop and the tools to get online. Working closely with schools and colleges, these have now been supplied to those students identified as being in the most need.
This investment is part of the new Greater Manchester Technology Fund, which aims to provide learners at risk of digital isolation with the technology and connectivity needed to continue their learning at home while schools and colleges remain closed. We are grateful to business partners who have made their own investments to support this fund.
We know that the COVID-19 pandemic and the measures needed to counter it have had a significant impact on many people’s mental health. To support people at this time, GM has launched a range of digital services and online support for children and adults across the city region to minimise the need for people to attend GP surgeries or hospital. These services can be accessed by people who are already experiencing mental health issues as well as people who may be struggling with the new social distancing and self-isolation restrictions.
As we look to Greater Manchester’s recovery in the aftermath of the pandemic, we will look to better understand the existing and emerging inequalities in our society and consider how tackling these inequalities should feature in a refreshed Greater Manchester Strategy, and how this work aligns with our wider ambitions to ‘build back better’. As part of this work, we are now developing plans for an Independent Inequalities Commission, which will undertake an in-depth analysis of the inequalities that exist within our city region.