Reaction: Manchester set to become England's first devolved health economy
Health leaders react to the news that Greater Manchester local authorities and CCGs will take on the joint commissioning budget for health and care from NHS England.
Dr Tracey Vell, LMCs honourary secretary
We hope that the budget deficits are not plugged by health care budgets. We would have to develop a better working relationship and see the details before we comment further.
Dr John Hughes, a GP in Manchester who has recently retired from the GPC and the LMC
We probably need more money than other areas but this budget is based on these alleged fair shares. So it is probably not an adequate budget for the health needs of Manchester, so I see problems with that.
Then there is the conflict between public health, local authorities and primary care, the fact that social care budgets have been slashed and are about to be cut further. So I am quite sure that money will be leaked from the health side to social care to fill those holes.
There are the Prime Ministers’ Challenge Fund pilots going on around Manchester, in which CCGs are already working with local authorities to some extent, but those have been mainly focused on extending access and I’m not sure that is the most pressing priority for Manchester. They have claimed a 15% reduction in A&E attendances but I haven’t seen any hard evidence behind that.
If this 8-8, 24/7 GP access is going to be rolled out this is going to use up money that perhaps should be better used for longterm conditions.
There is also, in Salford, Salford Royal [NHS Foundation Trust], which has proposed a primary care integrated care system with the acute trust as the lead provider. And again that could mean that the secondary care sector would be in charge of all the money for integrated care and, again, primary care may well lose out on funding.’
Dr Mark Porter, BMA council chair
We need assurances on who is responsible if these changes go wrong. Doctors believe the secretary of state for health should have the duty to provide a universal and comprehensive health service, and must take responsibility for guaranteeing national standards in the of quality care across the country, especially if the delivery of care is to be devolved to local authorities.
The NHS has just undergone unprecedented upheaval, there must be no more games with our health service and we need to avoid a situation where the NHS moves from being a national to a local political football.
Richard Humphries, assistant director of policy at The King’s Fund
The news that Greater Manchester’s local authorities and NHS are close to agreeing a deal with NHS England to establish a new partnership for health and social care across the Manchester region is very significant.
If implemented effectively, this could be a step towards a big prize - a single, seamless health and social care system delivering integrated care for people in Greater Manchester. It also provides an opportunity for councils and the NHS to work together to improve health and well -being in the region.
While the ambition is welcome, more details are needed about how the partnership will work in practice and who will be accountable for £6 billion of NHS resources involved in the deal. It will be important to avoid the distraction of further organisational change and to clarify the accountability of the Health Secretary for the NHS as a whole alongside a greater role for local government.
Manchester has been chosen to test out this new way of working because of the strength of local relationships. It is unlikely that many other areas are yet in a position to follow its lead.
Rob Webster, chief executive of the NHS Confederation
[I]t is great to see an example where a local health system is looking to take bold action. We will be following this work with interest. In particular, we will be looking to support all of our members in their efforts to transform health and care and understand how to work with local people on shared priorities.
If we are to tackle the challenges that face the health and care system then local organisations will need to work in different ways. Leaders need to look beyond the boundaries of their individual organisations, instead developing shared priorities for their area and working collaboratively with other organisations to improve the health outcomes of their local community.
The focus of politicians and arms length bodies must be to create the right environment to allow this sort of approach, offering support and looking to remove any barriers to new ways of working which improve patient care.
What this example does demonstrate is the role CCGs are playing, working with partners in local government to drive improvements in care. It’s also positive that providers of healthcare have been engaged in this work. It’s vital that all sorts of providers, including community, mental health, acute, and ambulance, are fully involved in these plans.
We are pleased to see that the changes in Manchester are being locally driven, rather than a centrally imposed initiative. Manchester’s plan is an example of changes resulting from good partnership working and strong relationships between health and care leaders, who are showing they can put the interest of the local population ahead of their own organisations.’
Leila Williams, Healthier Together’s director of service transformation
Health groups in Greater Manchester have been working with local authorities for some time to join up care between GP surgeries and social services, linking in with hospitals. We recognised that the changes proposed to hospital services will only succeed if there are changes to primary care and integrated care.
The devolution of the £6bn annual health and social care budget will allow Greater Manchester health groups and councils to reshape the way that health and social care services are delivered and ultimately improve health and wellbeing for the people of Greater Manchester.
We want to keep people healthy and independent for as long as possible and avoid so many people needing hospital care in the first place. This is genuine opportunity to enhance health outcomes for the people of Greater Manchester by aligning health and social care and public sector reform.
Lord Peter Smith, chair of Greater Manchester Combined Authority (GMCA)
We are committed to working in partnership with our NHS colleagues throughout the city region to take this forward and I would like to thank those colleagues, and NHS England, for their hard work so far in enabling us to reach this point. By ensuring that decisions about health for Greater Manchester are taken in Greater Manchester, we can ensure we have a system specifically tailored to the needs of people in our area.
Councillor Cliff Morris, GMCA lead on health
Our ambition is clear: To move from being one of the places with the worst health outcomes in the country to becoming one of the best and we believe this could be a huge step towards that goal. By fully integrating health and social care we can focus on preventing illness and promoting well-being across all age groups.
George Osborne, chancellor
We’re discussing a plan for bringing together the NHS and social care in Manchester so we provide better care for patients. This is exactly what we want to see more of in our health care. It’s also about giving Greater Manchester more control over things run in Greater Manchester - which is what our vision of a Northern Powerhouse is all about. It’s early days, but I think it’s really exciting development. We’ll be working hard now with Greater Manchester and NHS England on getting the details right so the arrangements work best for patients.