Manchester authority is set to take control of £6bn worth of health and social care spending
BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1110 (Published 26 February 2015) Cite this as: BMJ 2015;350:h1110
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Dear Sir/Madam,
The plan to pass control of the entire health and social care budget of £6 billion annually to Greater Manchester local authority is bold, innovative and exciting. It is a landmark on the NHS’s route towards a holistic, integrated service which unites health and social care(1).
But what is good for Manchester is also urgently needed in London. London faces a high burden of illness, both physical and mental, health inequalities remain stubbornly widespread and quality of care is too variable.
The London Health Commission (2), which I chaired, recommended last October a switch from care focused around the NHS to care focused around Londoners – groups of similar individuals with similar needs - whether this be for quick convenient care (professionals in work), continuity and a focus on their social needs (older people) or care that comes to them (people with intensive needs).
To achieve this, we need more joint teams in the community, more joined up working and more integration between health and social care. Running health and social care separately no longer makes sense. The current arrangement creates confusion, perverse incentives and distress for individuals trying to navigate an NHS free at the point of use and a social care system heavily needs- and means-tested.
London has a history of successful change as illustrated by its radical reform of specialist stroke services, now delivering a 30-day mortality rate 17 per cent below the England average. Manchester’s leaders are to be congratulated on seizing the initiative and negotiating an historic deal to reform care in their great northern city. London’s leaders should not dally, but follow swiftly in their path.
Professor the Lord Darzi of Denham
(1) http://www.bmj.com/content/350/bmj.h1110
(2) http://www.londonhealthcommission.org.uk/
Competing interests: No competing interests
2020--"Following the success of the Manchester Health Plan in introducing new funding streams for healthcare, co-payments and obligatory health insurance are now resulting in a surge in investment in hospitals and medical employment throughout the UK."
Competing interests: No competing interests
Re: Manchester authority: an example NOT to be followed hurriedly elsewhere
I do not know whether any of the advisors of the Central government and of "Manchester " ever worked in local government of the pre-1974 era. Lord Darzi certainly was not around at that time.
I did, as I did in a Board of Governors' hospital, various HMC hospitals, accountable to the Secretary of State through the RHBs.
The local authority public health services worked on the parish pump principle. It worked as we had a defined population with a defined budget. Except for the contraception services which were really only funded for the parish pump women but our staff and agents turned a Nelsonian Eye to domicile matters. Foreigners, ie, women from outside the borough, even from outside Great Britain giving a false address were never asked for proof.
Q. Would Manchester and its equally misguided followers be able to cope with " foreigners" for the whole gamut of complicated hospital services?
In those far-off days of long ago, Sir Keith Joseph designed the new NHS. His successor, the Red Queen of the Castle (Mrs Barbara Castle who took up the offices vacated in the Elephant and Castle) said that the new scheme of things was not to her liking but she would try to make it work.
Q. Will the conservatives, the labour, and other parties hopeful of running the for the next five years tell us NOW, whether they know how to make Manchester work?
Q. If Manchester is going to be independent, will the Secretary of State keep his (her) hands off? If so, will the S o S 's salary be reduced proportionately?
The late Sir Keith decreed that the local authority social services departments shall NOT have medically qualified persons as directors. He did not and in law could not give marching orders to the doctors who were already in post as directors of social services (in Newham and in Manchester). In one very large authority, where a doctor had been offered the job, Sir Keith vetoed the appointment.
Q. Has the government decided the professional criteria that the person to be appointed as director of the combined services should meet? If so, what are these? Will the director be appointed by the Council, without interference by any person or organisation! Will the director be accountable to the Council DIRECTLY, or, heaven forbid, through the Chief Executive? Will (s)he have the right to speak to the public, on all matters, without having to seek permission from any person or any body?
I pose this question because at present some, maybe many, directors of public health are accountable through another director.
There are other points needing clarification but enough for today. Possibly, there will be silence. Or, the clarifications may be as transparent as the mud of Westminster.
Competing interests: Old man. Needs intermittent NHS care. Hopes he will die before he needs social services care