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| New concerns raised over devolving health to regions | New concerns raised over devolving health to regions |
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| The King’s Fund health thinktank has voiced worries about plans to devolve NHS budgets. In a briefing paper on health and social care devolution, published on Wednesday, it says: “A key concern is whether the NHS can cope [with devolution] at the same time as it attempts to tackle some of the pressing challenges it currently faces. The NHS is already under considerable pressure, needing to act urgently to tackle growing financial and operational pressures.” | The King’s Fund health thinktank has voiced worries about plans to devolve NHS budgets. In a briefing paper on health and social care devolution, published on Wednesday, it says: “A key concern is whether the NHS can cope [with devolution] at the same time as it attempts to tackle some of the pressing challenges it currently faces. The NHS is already under considerable pressure, needing to act urgently to tackle growing financial and operational pressures.” |
| The warning comes as Greater Manchester is preparing to become the first region in England to have its £6.2bn health and social care budgets brought together and removed from central government control. Cornwall is not far behind, and around 20 more areas have put in health and social care devolution bids to the Treasury. | The warning comes as Greater Manchester is preparing to become the first region in England to have its £6.2bn health and social care budgets brought together and removed from central government control. Cornwall is not far behind, and around 20 more areas have put in health and social care devolution bids to the Treasury. |
| Greater Manchester, which has a population of 2.8 million, has some of the worst health outcomes in the UK, with life expectancy for both men and women below the national average. Its health and social care system faces a deficit of around £2bn over the next five years. And last month it was revealed that Manchester’s mental health trust faces closure because of a £7m black hole in its finances. Everyone agrees that something needs to be done and, on the surface, devolution sounds like an attractive solution. Integrating health and social care functions and budgets to create a single commissioning function would suggest a smoother patient journey and financial savings, for example, by reducing hospital admissions and delayed discharges of elderly patients by spending money on a support package to allow them to be cared for at home. | Greater Manchester, which has a population of 2.8 million, has some of the worst health outcomes in the UK, with life expectancy for both men and women below the national average. Its health and social care system faces a deficit of around £2bn over the next five years. And last month it was revealed that Manchester’s mental health trust faces closure because of a £7m black hole in its finances. Everyone agrees that something needs to be done and, on the surface, devolution sounds like an attractive solution. Integrating health and social care functions and budgets to create a single commissioning function would suggest a smoother patient journey and financial savings, for example, by reducing hospital admissions and delayed discharges of elderly patients by spending money on a support package to allow them to be cared for at home. |
| Related: Greater Manchester councils to control £6bn of health spending - report | Related: Greater Manchester councils to control £6bn of health spending - report |
| The King’s Fund says it is in favour in principle of the locally named DevoManc, but its report makes clear that the best available international research provides no proof that it will work. The speed of the introduction of these changes is rattling many nerves, as it allows for no pilots. Although only announced in February 2015, what is being billed in Manchester as “the most compelling story of health and social care transformation in England ever seen” is scheduled to go live by 1 April, 2016, after only 14 months of preparation. | The King’s Fund says it is in favour in principle of the locally named DevoManc, but its report makes clear that the best available international research provides no proof that it will work. The speed of the introduction of these changes is rattling many nerves, as it allows for no pilots. Although only announced in February 2015, what is being billed in Manchester as “the most compelling story of health and social care transformation in England ever seen” is scheduled to go live by 1 April, 2016, after only 14 months of preparation. |
| The report says: “While this sense of urgency may have contributed to the energy and excitement we are seeing in local communities, it is important that areas think carefully about taking on new responsibilities at a time when public services are experiencing unprecedented pressures.” | The report says: “While this sense of urgency may have contributed to the energy and excitement we are seeing in local communities, it is important that areas think carefully about taking on new responsibilities at a time when public services are experiencing unprecedented pressures.” |
| Matters have had to move at a pace since the signing of the memorandum of understanding between Greater Manchester’s 12 clinical commissioning groups (CCGs), 15 NHS providers, 10 local authorities and NHS England. These 37 local organisations have already agreed to the pooling of £2.7bn of joint resources across the 10 boroughs. A shadow strategic partnership board has been set up, announcing a number of far-reaching initiatives such as seven-day primary health care across the region. It has also submitted draft proposals as part of the government’s spending review process, requesting a multi-year settlement and additional funds to cover the costs of the changeover. | Matters have had to move at a pace since the signing of the memorandum of understanding between Greater Manchester’s 12 clinical commissioning groups (CCGs), 15 NHS providers, 10 local authorities and NHS England. These 37 local organisations have already agreed to the pooling of £2.7bn of joint resources across the 10 boroughs. A shadow strategic partnership board has been set up, announcing a number of far-reaching initiatives such as seven-day primary health care across the region. It has also submitted draft proposals as part of the government’s spending review process, requesting a multi-year settlement and additional funds to cover the costs of the changeover. |
| The health changes are underpinned by decades of integrated working by 10 council bosses which in April 2011 led to the creation of the Greater Manchester Combined Authorities (GMCA). This has gained the region George Osborne’s support for wider devolution to create the “northern powerhouse”. | The health changes are underpinned by decades of integrated working by 10 council bosses which in April 2011 led to the creation of the Greater Manchester Combined Authorities (GMCA). This has gained the region George Osborne’s support for wider devolution to create the “northern powerhouse”. |
| A permanent boss has not yet been appointed by NHS England and the GMCA to lead the health and social care devolution programme (DevoManc health). Ian Williamson, fomer chief officer of central Manchester CCG, has an interim leadership role. He says: “More of the same is simply not an option any more. Our vision is to ensure the greatest and fastest possible improvement to the health and wellbeing of the people of Greater Manchester.” | A permanent boss has not yet been appointed by NHS England and the GMCA to lead the health and social care devolution programme (DevoManc health). Ian Williamson, fomer chief officer of central Manchester CCG, has an interim leadership role. He says: “More of the same is simply not an option any more. Our vision is to ensure the greatest and fastest possible improvement to the health and wellbeing of the people of Greater Manchester.” |
| The shadow board has set itself a number of ambitious goals by 2020, which include “64,000 fewer people with chronic conditions” and “6,000 fewer people with cancer”, based on the best current practice in the NHS. | The shadow board has set itself a number of ambitious goals by 2020, which include “64,000 fewer people with chronic conditions” and “6,000 fewer people with cancer”, based on the best current practice in the NHS. |
| The most worrying of the King’s Fund’s question marks is over who has ultimate responsibility if something major goes wrong. Health devolution bosses say that the budgetary buck stops in Greater Manchester, but they are still negotiating with the health regulator, Monitor, and the NHS Trust Development Authority to decide where responsibility lies. | The most worrying of the King’s Fund’s question marks is over who has ultimate responsibility if something major goes wrong. Health devolution bosses say that the budgetary buck stops in Greater Manchester, but they are still negotiating with the health regulator, Monitor, and the NHS Trust Development Authority to decide where responsibility lies. |
| Meanwhile Williamson’s post has not yet been advertised, and the publication of details of precisely how health and social care is going to change on 1 April 2016 will not be made public until the launch of a strategic plan next month. | Meanwhile Williamson’s post has not yet been advertised, and the publication of details of precisely how health and social care is going to change on 1 April 2016 will not be made public until the launch of a strategic plan next month. |
| The apparent suddenness of DevoManc health’s appearance on the scene and the breakneck speed of its timetable, has raised concerns among local health activists and groups of NHS staff. Retired geriatrician, writer and member of Stockport NHS Watch, Professor Ray Tallis says: “We are outraged at the non-democratic nature of the process that led to the declaration of DevoManc. Many key figures – including some local MPs – knew nothing of it until the last minute. The public was kept in the dark.” | The apparent suddenness of DevoManc health’s appearance on the scene and the breakneck speed of its timetable, has raised concerns among local health activists and groups of NHS staff. Retired geriatrician, writer and member of Stockport NHS Watch, Professor Ray Tallis says: “We are outraged at the non-democratic nature of the process that led to the declaration of DevoManc. Many key figures – including some local MPs – knew nothing of it until the last minute. The public was kept in the dark.” |
| The first major decision taken by DevoManc is illogical and irrational. It is not fit for purpose | The first major decision taken by DevoManc is illogical and irrational. It is not fit for purpose |
| Many medical colleagues agree. On Saturday more than 1,000 staff from Wythenshawe hospital in south Manchester, including doctors, consultants and nurses marched alongside local residents and MPs, in protest against what they see as the downgrading of a specialist teaching hospital. Williamson says the move is one of the first decisions on services under the devolution umbrella. It was actually taken by Healthier Together - a programme led by 12 local clinical commissioning groups - that is a building block within a fully devolved devolved health and social care system in Greater Manchester. | |
| A group of the surgeons have formed a limited company called Keep Wythenshawe Special (KWS) which has successfully applied for a judicial review of what it describes as the “flawed decision” made on Wythenshawe hospital and on emergency surgery. Agreement to a judicial review is a serious blow to Manchester’s devolution process. | |
| One of the directors of KWS, surgeon Andrew Macdonald says he and his colleagues are in favour in principle of health devolution but that the process is a “complete shambles”. He says: “The first major decision taken by DevoManc [health] is illogical and irrational and will lead to a loss of integrity of one of the largest and most successful hospitals in the UK. Whatever our support for its aims, we can only conclude that it is not fit for purpose in its current form.” | One of the directors of KWS, surgeon Andrew Macdonald says he and his colleagues are in favour in principle of health devolution but that the process is a “complete shambles”. He says: “The first major decision taken by DevoManc [health] is illogical and irrational and will lead to a loss of integrity of one of the largest and most successful hospitals in the UK. Whatever our support for its aims, we can only conclude that it is not fit for purpose in its current form.” |
| Chris Ham, chief executive of the King’s Fund, says: “The real question comes back to this: what is the core objective of devolution in relation to health and care? Is it reducing health inequalities, delivering locally-tailored, integrated care and improving population health? Or is it a way of achieving savings and reducing spending in the future?” | Chris Ham, chief executive of the King’s Fund, says: “The real question comes back to this: what is the core objective of devolution in relation to health and care? Is it reducing health inequalities, delivering locally-tailored, integrated care and improving population health? Or is it a way of achieving savings and reducing spending in the future?” |