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Method or madness?

Method or madness?
23 April 2015

All eyes are on Greater Manchester following the devolution of funds for health and social care. What does it mean and how soon will others follow?

All eyes are on Greater Manchester following the devolution of funds for health and social care. What does it mean and how soon will others follow?

Manchester is a great example of a city that can handle change. When the industrial revolution took hold of what was once a town, turning it into a city, it subsequently thrived beyond anybody’s expectations.
The same is hoped for the the metropolitan county, made up of 10 boroughs, as it takes control of the combined health and social care budget of £6 billion in the historic deal that is, to use the vernacular, Devo Manc.
The new management of the billion pound budget was agreed by NHS England after a memorandum was finalised and signed by the chancellor, George Osborne and the secretary of state for health, Jeremy Hunt.
The historic agreement came after Greater Manchester’s 12 clinical commissioning groups (CCGs), 15 NHS providers, 10 local authorities and NHS England worked together to develop a business plan for the integration of health and social care across Greater Manchester. They will jointly decide on integrated care to support physical, mental and social wellbeing for its population.
The approved Memorandum of Understanding will give local people the right to make decisions regarding the health of the local population in primary care settings, therefore, it is hoped, easing the pressure of A&E resources.
The changes came into effect on 1 April with the full devolution being brought into place by April 2016.
The devolution comes off the back of the NHS’s Five Year Forward View that argues “for a more engaged relationship with patients, carers and citizens so that we can promote well-being and prevent ill-health”.
Simon Stevens, chief executive of NHS England, said: “[The] landmark agreement between NHS England, the local NHS and local government leaders charts a path to the greatest integrations and devolution of care funding since the creation of the NHS in 1948.
“… Greater Manchester now has a unique opportunity for innovation and improvement in health and wellbeing. The eyes of the country will now be on what this new partnership can deliver.”

The delivery
The delivery of this great change is a key element of the devolution. Dr Ranjit Gill (above), chief clinical officer of NHS Stockport CCG, believes the new system will “turn the model of care upside down”.
He says: “NHS care as an organisation has been around the needs of hospitals and the care and services they provide first, so we have had to bend the needs of the patients to the needs of the system.
“What we are going to do to change that is build a new model of care based on the needs of the patients built from prevention, proactive predictive care and then integrating tightly with primary care, community, mental health and social care.”
One of the aims of the devolution has always been to interact with the people of Greater Manchester on a closer level. “We want to work with the public to find the latest ways of preventing ill health and treating conditions much earlier on,” said Gill.
According to Gill only half the disease burden in the city have been found.
“Take diabetes for example. Of the people who have diabetes we’ve only found about half of them. We want to help the public understand that if we can identify the disease it’s good for the public and makes a much more efficient health system.
“With greater control over the budget, specialising, commissioning and general practice we are now able to do this.”

What it means for other CCGs
The general feeling among the profession is that it is a positive step for the NHS and patients.
The outcomes in Greater Manchester will be closely watched by other local authorities, CCGs and councils in England. Nadim Fazlani, chair of Liverpool CCG, says: “I don’t have a crystal ball to see what the Memorandum of Understanding is going to be like in practice, but I think the principal that we are moving away from a very centrally controlled NHS to an NHS where standards are set nationally but then allocated locally, where we have far more say on how we spend it, makes sense for our populations.
“What makes sense for Buckinghamshire might not work for Liverpool.”
Fazlani continues: “I don’t think anybody is advocating depending on where you live you get a different form or standard of health care.
“I think there should be a balance between what should be nationally determined and what should be locally determined. And this is a conversation which we needed to have with or without the devolution.”
The framework that has been outlined for Greater Manchester is a model that works in this particular area. As Fazlani points out: “We are also having conversations with our local authority. The issue is at what scale we work on. It may not be that Greater Manchester is a model we will all adapt to.”
The devolution is very much based on an agreement between NHS England and Greater Manchester.
The framework for health and social care was created from a partnership between the two organisations.
But the sole responsibility that will fall on Greater Manchester is, according to Julie Wood director of NHS Clinical Commissioners, “very early days with a lot of detail yet to be worked out. It has been an ambition for this to be done for quite some time, but it’s very much a locally driven plan and that’s good and great”.

A united front
For the rest of England it’s a case of waiting to see what will happen.
    Wood stresses: “It’s really important it’s not a top down mandate. It should be something that is locally determined by the people on the ground who have got the responsibility for health and care commissioning together.”
The response from NHS England and Greater Manchester is that it is very much a move that will see Greater Manchester’s CCGs, local authorities and NHS providers unite.
This collaboration is something that Gill feels has been in force for CCGs in Greater Manchester prior to the devolution.
He says: “Since the inception of the CCGs we chose to work closely together, we recognise Greater Manchester as a system and we also recognise that a single clear commissioner voice was a fitting and necessary thing to affect proper clinical commissioning.
“This now means taking that to the next level and really making sure that we, CCGs, in Greater Manchester work closely together.”
Although this move is welcomed by the authorities in Greater Manchester it will be the people who live there who are affected on the frontline.
Cllr Gary Porter, vice-chairman of the Local Government Association (LGA), says: “Devolving control of social care and health spending to Greater Manchester is good news for the people who live there and now needs to be replicated for people across the rest of the country.”
This is an opinion that is repeated by some but many feel it is to early to make such a bold move across England until results start to appear from Greater Manchester.
As Wood explains: “It’s good to see that it’s happening but we really want to see more of the detail and see what that means when things operate in reality.”
There’s no way of seeing into the future, but basing outcomes on how Manchester has handled its evolution in the past, it is perhaps a model that many others will want to adopt.

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