The surprise announcement that Greater Manchester is to take responsibility for £6bn worth of health and social care spending from April 2016 presents either a visionary revolution to improve health outcomes for the people of Greater Manchester or the start of the dismantling of the ‘national’ health service.
Many involved in, and commenting on, the health sector in England have realised for some time that there needs to be greater integration between health promotion, healthcare and social care. Recent media coverage of the rise in ‘bed blocking’ has highlighted the issue to a wider audience. In theory, the proposed arrangement in Greater Manchester will enable local politicians and health professionals to make a marked improvement in the lives of the populace, ensuring a co-ordinated approach to delivering better health and life opportunities via interventions in lifestyle, housing and work. Proponents of the plan believe that additional local standards can be applied to health and care outcomes that go above those required nationally, aligned to leading regional regulatory oversight.
Without the full details, there is a lot of speculation as to how this proposal will work in practice. New governance arrangements between NHS England, 12 local clinical commissioning groups and 10 councils will need to be sufficiently robust, transparent and effective to ensure that appropriate scrutiny and challenge can be applied. Above all, the line of accountability needs to be clear and easily understood by the local and national electorate. This will mean fundamental changes on a local level, in the first instance, if not to the wider health service in the longer term.
There are many fears that the plan could lead to the further fragmentation of the NHS, with other regions seeking to establish a similar arrangement with their own locally-driven priorities. Others are concerned that local politicians do not have the strength of character to take the tough decisions regarding the closure of popular, but unsustainable facilities, dependant as they are on local voters to re-elect them. The issue of marrying two services that have separate funding streams also presents some practical and philosophical challenges: who decides when universally funded services end and when means-testing comes into play?
Experiences of similar arrangements in Scotland and Northern Ireland highlight some of the challenges that the plans present, however, the provider and regulatory environment is significantly different. The move is definitely bold, time will tell if it is indeed a great leap forward in the evolution of the NHS.
|Louise Thomson is Head of Policy (Not-For-Profit), at ICSA: The Governance Institute|