Category Archives: Manchester

The announcement in February 2015 that local councils in Greater Manchester would be given a say in the management of the NHS in the conurbation generated a lot of publicity. This is an attempt to make sense of what has happened since.

The announced devolution of powers in relation to the NHS doesn’t amount to very much. All the laws, regulations and structures which apply in the rest of England still apply in Manchester. That is not the case in Wales, Scotland or Northern Ireland. This is more like delegation than devolution.

DevoManc

A Memorandum of Understanding was agreed by NHS England, 12 NHS Clinical Commissioning Groups, 15 NHS providers and 10 local authorities. It establishes a health and social care partnership board which manages the £6 billion annual budget and a £450million transformation fund. This gives local councils a formal role in the management of health care – something they have not had since 1974. The board are developing a common technology strategy, which is intended to to enable the sharing of patient records between different organisations. They have also agreed a common approach to public health – something which councils have been responsible for since 2012.

A strategic plan has been agreed in each borough, and these are developing independently. There will be some concentration of specialities into fewer centres, so, for example, it is proposed to establish four centres for elective orthopaedic surgery, and three centres for emergency surgery so these will not be provided in every borough. This concentration will require considerable capital investment and it is not clear where that will come from.

The intention is to integrate health and social care, and establish what are called local care organisations. These involve bringing adult social care staff into NHS organisations. This happened in Salford some time ago, and is developing in other boroughs. Social care is still meanstested. It is difficult to see what this means in practice. Given that the councils’ budgets have been reduced substantially it seems likely that NHS funds will be used to support social care, as it is much cheaper for trusts to move people into residential care, or pay for equipment than to keep patients in hospital. It has certainly meant that social care staff are under a lot of pressure to get services organised if they are needed to get people out of hospital.

In Manchester City itself involving local councillors has generated some radical changes. Three hospitals, currently run by three different NHS trusts, are in the process of amalgamating into a single organisation. The three Clinical Commissioning Groups have merged into one and are to move into the City Council. A tender has just been announced to run all health and social care services outside hospital. Over ten years this would amount to £6 billion. The hospital consortium is an obvious bidder. At the time of writing it is not clear if there will be any other bidders. This local care organisation would run social care and manage the contracts of voluntary organisations. According to the commissioners it will… “not only improve health outcomes and support people to live independent lives, but also gives us a way of addressing some of the financial pressures we face. “

It remains to be seen whether this approach will give better results than those taken in the rest of England.

This is a personal view.  It first appeared in The Pensioner.

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A new, independent and broad-based citizens’ initiative – the People’s Plan – was launched in Greater Manchester last October and has now published its findings.  This extract covers health and care  – but other parts of the plan would also impact on health. 

People's plan

Since 2016 Greater Manchester has responsibilities for managing and integrating hitherto separate, centrally funded NHS services and local authority adult care services. Both services are in crisis: in adult care, austerity budget cuts have reduced numbers receiving home care by some 20% nationally; and in health services, the halving of the number of hospital beds over the past thirty years has created a fragile system that suffers with demand peaks or delayed discharges. The National Audit Office has questioned whether integration of health and care will save money or reduce hospital admissions; and this finding is ominous when Greater Manchester has a predicted £2 billion shortfall in health and care expenditure within five years. Against this background, it is unclear how Greater Manchester will find the policy levers, financial resources and political will to tackle prevention of ill health and low life expectancy in deprived localities.

Challenge 1:How to lever in more financial resources for health and care services, where social ownership and operation of free services should be defended

Event participants recognised that “services cannot be run without proper funding” and the first priority of survey respondents is levering in more public funding. In health, as in housing, what citizens want is public provision that depends on reversing austerity cuts. By implication, the Greater Manchester mayor and other Greater Manchester politicians need to change central priorities as much as manage local services; as a Bury event participant put it: “make it the Mayor’s job to fight for more money for local services”.

The other clear theme is that public funding should support socially owned and operated services. While voluntary and other third-sector providers are often complimented, references to private providers in health and care are mostly negative: “Resist the influence of the private sector, because it takes money out of the system”; other respondents had concerns for poor pay and conditions in outsourced adult care.

Pointers on what to do:

  • Lever in more public funding.

83% of all survey respondents agreed that ‘Greater Manchester should urgently seek a better funded deal for health and social care’ – with just 2% opposed. Here again, as in other policy areas, like housing, what respondents want the Greater Manchester mayor and other Greater Manchester politicians to do is not just manage the system within existing funding limits but claim more resources. For example, investment in training for ongoing supply of nurses in Greater Manchester services is an area where consequences of cuts to bursaries are a serious concern.

  • Use public funds to support not-for-profit and publicly owned and operated services.

Survey respondents and event participants were against further outsourcing or privatisation. Health and care services need new ‘step down’ facilities for discharged hospital patients who cannot go back to their own homes and do not have a care home bed; but 67% of all survey respondents believed such facilities should be built and operated by NHS providers and 74% also supported provision by other not-for-profit providers, with only 10% supporting private for-profit providers.

People's Plan

Challenge 2: Build a new kind of NHS as a civic institution which offers a wide range of stakeholders more participation in decision-making as well as providing more user-friendly services

Citizen attachment to the NHS is not all sentimental and uncritical. Ministers and managers have sought to restructure health and care services so that they meet user demands more effectively, but citizen critics go further and ask for a redefinition of the NHS as a new kind of civic institution where a wide range of local stakeholders would have a major influence over decision-making.

At a café-style event conversation about ‘Devo Manc’, participants posed a challenge to “find ways to put health and social care close to communities”. There is widespread dissatisfaction with current forms of consultation that are too often about changes already decided by service managers.

Pointers on what to do:

  • Experiment with direct public participation in decision-making.

65% of all survey respondents wanted direct participation by the public for proposed changes, through means such as online polling, for example, whose results could not be easily ignored.

  • Create an advisory board representing wider interests.

More traditional forms of representative democracy have even wider support. 77% of all survey respondents wanted a wider advisory board representing different stakeholders including voluntary and community organisations as well as provider groups. For example, representation for those with learning disabilities and their many challenges was strongly featured in the Health and Care themed event.

  • Provide more user-friendly services on a local community basis.

This is the point where citizen priorities align with those of politicians and service managers. At a Greater Manchester Older People’s Network event and in surveys, the GP and hospital appointments systems were described as “barriers” to access, with specific criticism about the availability of “on the day” appointments; and at a Wythenshawe event the complaint was that “public transport never lines up properly with health services”

Challenge 3: How to put more resources into prevention and into the inadequately funded ‘Cinderella’ services of mental health and adult care, which have now been damaged by austerity cuts

Many of the open survey responses and comments of event participants highlighted the problem of ‘Cinderella’ services. Some event participants thought hospitals were claiming resources that should have gone to prevention, primary and community provision; all agreed with the survey respondent who wanted “greater emphasis on prevention not cure” and worried about how austerity cuts in mental health and adult care had aggravated long standing problems about service provision. The result is pervasive insecurity about service availability, crystallised by the question at one Tameside event: ”will it be there when you or your family members need it?”.

Pointers on what to do

  • Stop cuts to mental health services and increase funding.

This connects with prevention because, as one survey respondent argued, with more funding for primary care, GPs should be able to prescribe more one-on-one counselling and for more than six weeks.

  • Revalue the workforce in adult care.

Some open responses registered the point that care workers are paid and trained worse than health service workers, although they had an increasingly important role in an ageing society. As one respondent argued: ”properly trained care assistants would help people to stay at home”.

David was  one of the people involved in contributing/drafting/editing/finalising the plan, but he is not the sole author

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Statement by Labour candidates for election as governors of Greater Manchester Mental Health NHS Foundation Trust.

This is a challenging time for the NHS, particularly for mental health services. We are a group of Labour Party members campaigning for genuine parity of esteem for mental health, in order to ensure that patients get the full range of services and quality care that they deserve.

We believe that:

  • Prevention is always better than cure, where possible, through the promotion of wellbeing within the community and ensuring that support is available to people who need it sooner rather than later.
  • A variety of mental health training within schools, workplaces and communities is essential to reduce the number of admissions, combat stigma and promote mental wellbeing.
  • A&E and community services for people experiencing a mental health crisis are currently inadequate and must improve. No patient should have to stay in police custody due to a lack of beds.
  • Patients must be treated with the utmost respect and compassion, and their feedback valued along with the opinions of friends and family as well as the wider community.
  • Mental health services must be properly funded by the government, including funding aimed at tackling the social factors contributing to mental illness.

As Governors we will ensure that feedback from service users and their friends and families is kept at the forefront of care provision by Greater Manchester Mental Health NHS Foundation Trust. We will make certain that the Trust is properly represented in the “Devo Manc” environment so that services are adequately funded and supported across all of Greater Manchester.

Bryan Blears – Salford

Michael Crouch – Service User and Carer

Peter Dodd – City of Manchester

Thomas McAlpine OBE – City of Manchester

Simon Morton – Staff – Non-Clinical

Voting will open on 14th February 2017. Electors will receive an e mail containing unique voting details

This is the first time we have had an SHA slate in an election.  In England you can be a member of your local Foundation Trusts, and there are also many which have a category of membership for the whole of England. 

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Video of the three candidates Ivan Lewis, Tony Lloyd and Andy Burnham (links are to their initial statements) at our hustings on 25th June.

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“Some people believe football is a matter of life and death,” Bill Shankly, Liverpool FC’s manager between 1959 and 1974, once said. “I am very disappointed with that attitude. I can assure you it is much, much more important than that”. Now imagine the newspaper headlines if at the end of the football season three of the biggest English football clubs – Manchester City, Everton and Liverpool – were relegated from the league. If football were really a matter of life and death, this is exactly what would happen.

We put together a public health league table which ranks the areas local to the 2014-15 Premier League football clubs from best to worst using key health indicators with a corresponding code: the percentage of smokers (P, played); weight – percentage of obesity and overweight (W, won); deaths – all cause mortality rates per 100.000 (D, drawn); life expectancy for males in years (L, lost); female life expectancy in years (F, for); alcohol-related hospital admissions per 100,000 (A, against); and the gap or difference in life expectancy for men between the most and least deprived areas of the local authority in years (GD, goal difference).

The final league points represent the sum of ranks for each outcome. For example, Chelsea’s league-winning score of 114 points comes from ranking second for P, first for W, D, L, F, and A and last for GD.

Public Health League

While Chelsea would still be winners in the public health league table, Crystal Palace, Manchester United and Tottenham Hotspurs would join them in the top four, with West Ham in fifth place. As the bottom three in the table, Manchester City, Everton and Liverpool are all relegated.

The data we used came from PHE Outcomes Framework Data, the Office for National Statistics and the Public Health Observatory Wales. Premier League clubs were geo-referenced to the local area with which they are most associated, so Manchester United’s data, for example, is for Trafford Council, Chelsea FC is represented by data from the Royal Borough of Kensington and Chelsea, and Swansea is represented by data from the local health board (although the Wales average had to be used for the alcohol variable). Liverpool and Everton have the same data as their grounds, Anfield and Goodison,are located in the same local authority.

Life expectancies

Apart from throwing up some unusual league places, the league table also further demonstrates the extent of the north-south divide in health in England: the top half of the table is dominated by southern clubs and the relegated trio are all from the north-west. To those working in public health, this will not be surprising as the cities of Liverpool and Manchester have some of the worst health outcomes in the country. The contrast between winners Chelsea and relegated Manchester City in terms of life expectancy is immense at seven years for men and six years for women.

The PHLT also demonstrates the local health inequalities that exist within our towns and cities. So while Manchester United place in the top four, their “noisy neighbours” Manchester City are relegated. Life expectancy for men and women on the red side of Greater Manchester is four years higher than for those on the blue side – only a couple of miles down the road. This is probably related to the stark differences on these two sides of the same city in terms of economic deprivation with, for example, child poverty rates of 34% for Manchester City Council compared to 14% in Trafford.

Manchester death league

Even within local authorities there are high inequalities in life chances with, for example, a 14-year gap in male life expectancy between the most and least deprived areas of Chelsea.

The north-south health divide, local health inequalities, and inequalities within local authorities are a serious public health concern – to the extent that they were the subject of Due North, the first Public Health England commissioned independent review in 2014. This report recommended a number of ways in which central and local government and the voluntary sector and the NHS could help reduce these health divides. The league table is another way of showing these divisions and raising awareness of the inequalities in “life and death” that exist in our country today.

This was first published on The Conversation

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