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Could Manchester pioneers save NHS? Could Manchester pioneers save the NHS?
(about 7 hours later)
Greater Manchester will begin taking control of its health budget from April, after a devolution agreement was signed by the Chancellor, George Osborne.Greater Manchester will begin taking control of its health budget from April, after a devolution agreement was signed by the Chancellor, George Osborne.
Richard Humphries, assistant director of policy at think tank the King's Fund, sets out the fundamental points of how the new system is set to work.Richard Humphries, assistant director of policy at think tank the King's Fund, sets out the fundamental points of how the new system is set to work.
What is being proposed?What is being proposed?
At the moment, decisions about what kinds of health and social care services are available - or commissioned - are split between:At the moment, decisions about what kinds of health and social care services are available - or commissioned - are split between:
The idea is to bring together the separate budgets for all of these services - £6bn in total for Greater Manchester - and give these to a new body covering the whole of the area.The idea is to bring together the separate budgets for all of these services - £6bn in total for Greater Manchester - and give these to a new body covering the whole of the area.
Its job will be to make many major decisions about the future of services across the area.Its job will be to make many major decisions about the future of services across the area.
This is likely to mean that most health and care services - hospitals, community health services, primary care, social care and mental health services - will be commissioned within Greater Manchester.This is likely to mean that most health and care services - hospitals, community health services, primary care, social care and mental health services - will be commissioned within Greater Manchester.
A new strategic body will be formed - the Greater Manchester Strategic Health and Social Care Partnership Board - supported by a joint commissioning board drawn from the 10 local authorities, clinical commissioning groups (CCGs) and NHS England.A new strategic body will be formed - the Greater Manchester Strategic Health and Social Care Partnership Board - supported by a joint commissioning board drawn from the 10 local authorities, clinical commissioning groups (CCGs) and NHS England.
They have signed an agreement to work together, with the aim of having new arrangements in place from April 2016.They have signed an agreement to work together, with the aim of having new arrangements in place from April 2016.
Why is this being done?Why is this being done?
The idea of public bodies working together to use their resources collectively for the benefit of local people is not new.The idea of public bodies working together to use their resources collectively for the benefit of local people is not new.
This was encouraged by the previous government through its Total Place programme and continued by the present administration through "whole place community budgets".This was encouraged by the previous government through its Total Place programme and continued by the present administration through "whole place community budgets".
It is generally accepted that the NHS and local authorities should work much more closely together and share resources to meet the mixture of health and care needs that arise from an ageing population.It is generally accepted that the NHS and local authorities should work much more closely together and share resources to meet the mixture of health and care needs that arise from an ageing population.
This is currently being done on a smaller scale across the country through the Better Care Fund.This is currently being done on a smaller scale across the country through the Better Care Fund.
There has also been talk of Whitehall devolving some its powers and money to groups of local authorities so decisions are made closer to local needs and to promote economic growth - this is behind Chancellor George Osborne's idea of a "northern powerhouse".There has also been talk of Whitehall devolving some its powers and money to groups of local authorities so decisions are made closer to local needs and to promote economic growth - this is behind Chancellor George Osborne's idea of a "northern powerhouse".
Manchester's local authorities have a history of working together, so it has been at the forefront of this agenda.Manchester's local authorities have a history of working together, so it has been at the forefront of this agenda.
Towards the end of last year, the chancellor announced that powers for housing, planning, transport and policing would be devolved to a new directly elected mayor for the area.Towards the end of last year, the chancellor announced that powers for housing, planning, transport and policing would be devolved to a new directly elected mayor for the area.
What are the advantages of Devo Manc?What are the advantages of Devo Manc?
If it can be pulled off, there is a big prize for the people of Greater Manchester - drawing together the pieces of the health and care jigsaw into a more joined-up system that makes it easier to co-ordinate care around individual needs, prevent illness and promote wellbeing. This has been an aspiration of successive governments for decades.If it can be pulled off, there is a big prize for the people of Greater Manchester - drawing together the pieces of the health and care jigsaw into a more joined-up system that makes it easier to co-ordinate care around individual needs, prevent illness and promote wellbeing. This has been an aspiration of successive governments for decades.
The new set-up should mean that big decisions about future services, for example major hospitals, which affect the whole area, could be made within Greater Manchester, not outside it.The new set-up should mean that big decisions about future services, for example major hospitals, which affect the whole area, could be made within Greater Manchester, not outside it.
What are the risks?What are the risks?
Much depends on the detail of how it will work - which has yet to be agreed.Much depends on the detail of how it will work - which has yet to be agreed.
The biggest concerns are about accountability - who carries the can for the big sums of public money involved? Will decisions still be made by clinical commissioning groups and local authorities locally or will the new joint body be another layer of bureaucracy that will reduce local control? How will the risks be shared across organisations in Greater Manchester, for example if a major service runs out of money?The biggest concerns are about accountability - who carries the can for the big sums of public money involved? Will decisions still be made by clinical commissioning groups and local authorities locally or will the new joint body be another layer of bureaucracy that will reduce local control? How will the risks be shared across organisations in Greater Manchester, for example if a major service runs out of money?
And with both the NHS and councils struggling to make ends meet, there are bound to be worries that Greater Manchester is being handed a poisoned chalice.And with both the NHS and councils struggling to make ends meet, there are bound to be worries that Greater Manchester is being handed a poisoned chalice.
Some are concerned about giving elected members of local councils a bigger say in how the health service runs, but others argue that the NHS lacks local democratic legitimacy. The involvement of GPs and other NHS representatives in the joint body that will make decisions should allay some of these concerns - this not a wholesale transfer of the NHS to local councils.Some are concerned about giving elected members of local councils a bigger say in how the health service runs, but others argue that the NHS lacks local democratic legitimacy. The involvement of GPs and other NHS representatives in the joint body that will make decisions should allay some of these concerns - this not a wholesale transfer of the NHS to local councils.
Will it catch on?Will it catch on?
All parts of the country need to work out how best to join up public services so they meet the changing needs for health and care that many more of us will have in future - and how to keep the whole population healthier.All parts of the country need to work out how best to join up public services so they meet the changing needs for health and care that many more of us will have in future - and how to keep the whole population healthier.
But what works for a densely populated conurbation like Greater Manchester will not work for smaller towns and cities or for dispersed rural communities.But what works for a densely populated conurbation like Greater Manchester will not work for smaller towns and cities or for dispersed rural communities.
Greater Manchester's progress has been helped by good working relationships between local government and the local NHS. Elsewhere these are patchy.Greater Manchester's progress has been helped by good working relationships between local government and the local NHS. Elsewhere these are patchy.
The best examples of integrated care owe more to good relationships than they do to organisational structures.The best examples of integrated care owe more to good relationships than they do to organisational structures.
How has the King's Fund come to these conclusions?How has the King's Fund come to these conclusions?
The King's Fund set up an independent commission, led by Kate Barker, to explore the current health and social care systems in England and propose a new approach that redesigns care around individual needs.The King's Fund set up an independent commission, led by Kate Barker, to explore the current health and social care systems in England and propose a new approach that redesigns care around individual needs.
Its finding in 2014 were:Its finding in 2014 were:
Read the Barker Commission report in fullRead the Barker Commission report in full