The Big Conversation
Background information
Health and care in Greater Manchester are changing. People are living longer, many with more complex needs, and the pressures on health and care services have increased. At the same time, we know that where people live, how much money they have, their housing, work, family and community connections all affect their health.
We also know that not everyone experiences health and care equally. Some communities face bigger barriers to getting the support they need and experience poorer health outcomes as a result.
To respond to these challenges, organisations across Greater Manchester came together as part of the Integrated Care Partnership. The Partnership brings together the NHS, local councils, voluntary and community organisations and others, with a shared goal:
- to improve health, care and wellbeing for everyone, and to narrow the gaps between communities.
From the start, there was a clear commitment that this work must be shaped by the people who use services and live in our communities.
Why we started this work
We began The Big Conversation because we wanted to:
- Understand what matters most to people about their health and care.
- Learn from people’s real experiences good and bad.
- Check whether our plans reflected what life is actually like across Greater Manchester.
- Make sure the new Integrated Care Strategy was grounded in lived experience, not just organisational priorities.
People told us in the past that they did not always see how engagement made a difference. We wanted to do this differently by:
- Listening first, before final decisions were made.
- Being honest about the challenges facing health and care.
- Showing clearly how people’s views influenced the strategy.
The Big Conversation was designed to be open, inclusive and wide‑reaching, so that as many voices as possible could be heard.
Who we engaged with
We engaged with tens of thousands of people across Greater Manchester through Phase 1 and Phase 2 of The Big Conversation, using a mix of surveys, community‑led conversations and targeted engagement.
We listened to people from all parts of Greater Manchester, including those who use services regularly and those who may only need support occasionally, as well as people who often face the greatest barriers to good health and care.
This included:
- Members of the public with lived experience of NHS and care services
- People living with long‑term conditions or disabilities
- People experiencing mental health challenges
- Unpaid carers and families
- Children and young people
- Older people
- People experiencing disadvantage, poverty or insecure housing
We also worked closely with voluntary, community and faith organisations, who supported conversations with:
- Minority ethnic communities
- Refugees and people seeking asylum
- d/Deaf and Disabled people
- People experiencing homelessness
- Communities who are less likely to take part in traditional NHS engagement
We chose to engage in this way because:
- Some voices are heard more often than others, and we wanted to address this
- Community organisations are trusted and deeply connected to local people
- Lived experience provides understanding that data alone cannot
- A fair and effective health and care system must reflect the diversity of Greater Manchester
- By using different methods and working through trusted community partners, we aimed to make sure this engagement was inclusive, accessible and reflective of real experiences, rather than relying on a single approach.
Listening to people across Greater Manchester was a central part of developing the Integrated Care Strategy. We designed The Big Conversation in two phases so that engagement was meaningful, inclusive and able to genuinely influence decisions.
This phased approach allowed us to listen, learn, check our understanding, and then go deeper before any final strategy was agreed.
How phase 1 worked:
Phase 1 focused on hearing people’s initial thoughts, feelings and priorities about health and care in Greater Manchester. We asked broad, open questions about:
- What matters most about health and care.
- What works well and what doesn’t.
- Whether our overall direction felt right.
- What people felt needed to change.
People shared their views through surveys, community conversations and work with voluntary, community and faith organisations.
How phase 2 worked:
Phase 2 built directly on what we heard in Phase 1. It focused on more detailed questions about:
- Access to services.
- Lived experience of care.
- Inequalities and barriers people face.
- What would make the biggest difference to people’s lives.
We worked closely with community and voluntary organisations to reach people whose voices are often missed and to explore issues in more depth.
Why this approach matters
People told us they wanted engagement to:
- Be honest.
- Be inclusive.
- Lead to real change.
Running The Big Conversation in phases helped ensure the strategy was not written first and “consulted on” later, but built together over time.
This approach reflects our ongoing commitment to listening, learning and working with people and communities as partners not just during engagement exercises, but as the strategy is put into action.
How the phases worked and why we did things this way.
How the Integrated Care Strategy reflects what you said:
The final Integrated Care Partnership Strategy reflects a shift towards:
- Health and care designed with people, not just for people.
- Fewer silos and more joined up support.
- A stronger focus on fairness and inclusion.
- Recognition that good health starts long before someone needs a hospital or GP appointment.
- Sharing responsibility with councils, communities, and voluntary organisations.
Your views helped shape:
- The priorities we focus on.
- The values we commit to.
- How we measure success not just by activity, but by experience and outcomes.
Our strategy is available for download below or you can click the button
A short video about the ICP 5 year Strategy
Phases
GM ICP Strategy - Local Resident Feedback
Responding to resident feedback
Feedback about the Greater Manchester Integrated Care Partnership Strategy highlighted overwhelming support for the vision and commitments of the strategy. Inequalities and access to the right level of care were the two things respondents agreed with most.
In particular, respondents expressed overwhelming support for prevention strategies and reduction of health inequalities experienced by people in Greater Manchester with particular emphasis on the wider determinants of health including poverty and cost of living. They also expressed strong views about the need to education the public and enable people to take more control and responsibility for health and care choices.
Respondents also felt strongly about the commitment to enable people to access the right level of care where and when they need it. This included access to primary care, particularly GPs and dentists, mental health (with a focus on children and young people), a reduction in waiting lists and timely diagnostics and treatment.
Concerns
However, respondents did have concerns regarding the commitment (as described at that point in time) to ‘realise the opportunities from digital technology’ citing that there had been historical difficulties with the use of technology in health and care. There was also concern around services running effectively if face to face is replaced and the risk of excluding service users who are non-digital.
Responding to feedback
The themes highlighted above have been supported by other subsequent engagement. The most recent engagement draft of the ICP strategy, on which comments have recently been analysed includes access to care as key shared outcome (the GM we want to see) and inequalities is a fundamental aspect of the way we will work together – ‘Understand and take action to address inequalities in everything we do’. Prevention and early detection is one of the missions/priorities.
The challenges highlighted above are ones that are being addressed as the detail of the strategy is developed.
All insight gathered from the above has been used to develop the final 5-year Greater Manchester ICP Strategy. More information about how the feedback influenced the strategy can be found on the link below.