Public Sector Focus

Grabbing power

The leaders of the Greater Manchester health and social care devolution agenda spoke at the recent NHS Confederation annual conference in Liverpool to explain what they are doing and why. Adam Hewitt was there.

“Why Greater Manchester? Largely because it’s our idea.” 

Sir Richard Leese, leader of Manchester City Council, one of the 10 councils making up Greater Manchester Combined Authority (GMCA), was in no mood for modesty at the NHS Confederation annual conference. He joked that the Echo Arena was an appropriate venue for him to be speaking in, because of the “shockwaves” still reverberating around local government and the NHS once the scale of February’s devolution deal was announced. 

Sir Richard (pictured, far right) told the audience that although to outsiders the deal may have seemed to have come out of nowhere, in fact it has been almost 20 years in the making, with key milestones including the abolition of the old Greater Manchester County Council in 1986, a 1999 report by the English core cities, the 2011 approval of statutory status for the previously voluntary GMCA and the 2014 devolution agreement centred more on transport and skills. 

“All of this started with economic devolution, and ended up with health and social care a bit down the track,” Sir Richard said. He spoke of the need to tackle rampant health inequalities, especially in the city of Manchester itself, and the widespread desire to cut the number of hospital admissions for the over-65s. 

He said the approach taken with health and social care integration and devolution should be the same as taken with the ongoing ‘Healthier Together’ reconfiguration of services in the region: “We wanted something that didn’t have a relatively small number of specialist acute services leading on how we constructed our health system. It should start at a basic local level and work up.” 

Sir Richard said the devolution agenda has been aided by NHS England chief executive Simon Stevens’ ‘Five Year Forward View’ document, the wider public service reform agenda, and the closer working relationships between GPs and councils engendered by the creation of clinical commissioning groups and health & wellbeing boards. 

GP Dr Steve Kell, co-chair of NHS Clinical Commissioners, who chaired the panel at the event, agreed with this in his segment. He said: “I was just reflecting backstage, how as a GP, since CCGs came into being, so much of my role now is working with local authority colleagues. My perception of my job has changed [with] the introduction of ‘social prescribing’ and the realisation that – various academics say – between 40-70% of the health outcomes that affect my patients are related to socio-economic factors, whereas only 10-15% relate to the healthcare that I commission.” 

Sir Richard added: “Devolution allows us to commission at different spatial levels, starting with the city-region level; but to deliver services in an integrated, joined-up way at the family and neighbourhood level. I think the approach we’re taking has got risks attached to it, but it is evidence-based and we’ve built that evidence up through a number of routes over a number of years, and ultimately it needs to leave to a healthier and less dependent population.” 

He said it was important to integrate health and social in the context of the wider array of public services, particularly those addressing the neediest people, and said that the social determinants of ill-health need to be tackled. A population less dependent on expensive public services will ultimately make it easier to close the fiscal gap, he added. 

Ian Williamson, interim chief officer for Greater Manchester health and social care devolution, said: “I have been an accountable chief exec in the NHS for nine years. I now find myself with a true once-in-a-career opportunity.” 

Williamson said he was both “excited and apprehensive” about the scale of the opportunity and the challenges, adding: “Greater Manchester devolution is a huge step for the government and NHS England. Some would say it’s risky – if we don’t succeed, it will make it much harder for others to follow. My job, along with the 37 leaders of the [other] statutory bodies, is to make sure we succeed. 

“Our aim through devolution of health and social care is to ensure the greatest and fastest possible improvement to the health and wellbeing of the 2.7 million people of Greater Manchester. 

“We can achieve things together that we could never achieve separately. Our early priorities in this ‘build-up year’ range from improving primary care access, to a joined-up academic health and science system; from a place-based agreement with public Health England, to mental health and work programmes; from constructive early dialogue with Monitor and the [NHS] Trust Development Authority, to taking on specialist commissioning now. 

In a Q&A session following the talks, which also featured ResPublica think tank founder Phillip Blond on the changing role and nature of the state and public services, Four Seasons Health Care chair Ian Smith called events in Greater Manchester “one of the most important steps in the history of the NHS”.

“Why Greater Manchester? Largely because it’s our idea.” 

Sir Richard Leese, leader of Manchester City Council, one of the 10 councils making up Greater Manchester Combined Authority (GMCA), was in no mood for modesty at the NHS Confederation annual conference. He joked that the Echo Arena was an appropriate venue for him to be speaking in, because of the “shockwaves” still reverberating around local government and the NHS once the scale of February’s devolution deal was announced. 

Sir Richard (pictured, far right) told the audience that although to outsiders the deal may have seemed to have come out of nowhere, in fact it has been almost 20 years in the making, with key milestones including the abolition of the old Greater Manchester County Council in 1986, a 1999 report by the English core cities, the 2011 approval of statutory status for the previously voluntary GMCA and the 2014 devolution agreement centred more on transport and skills. 

“All of this started with economic devolution, and ended up with health and social care a bit down the track,” Sir Richard said. He spoke of the need to tackle rampant health inequalities, especially in the city of Manchester itself, and the widespread desire to cut the number of hospital admissions for the over-65s. 

He said the approach taken with health and social care integration and devolution should be the same as taken with the ongoing ‘Healthier Together’ reconfiguration of services in the region: “We wanted something that didn’t have a relatively small number of specialist acute services leading on how we constructed our health system. It should start at a basic local level and work up.” 

Sir Richard said the devolution agenda has been aided by NHS England chief executive Simon Stevens’ ‘Five Year Forward View’ document, the wider public service reform agenda, and the closer working relationships between GPs and councils engendered by the creation of clinical commissioning groups and health & wellbeing boards. 

GP Dr Steve Kell, co-chair of NHS Clinical Commissioners, who chaired the panel at the event, agreed with this in his segment. He said: “I was just reflecting backstage, how as a GP, since CCGs came into being, so much of my role now is working with local authority colleagues. My perception of my job has changed [with] the introduction of ‘social prescribing’ and the realisation that – various academics say – between 40-70% of the health outcomes that affect my patients are related to socio-economic factors, whereas only 10-15% relate to the healthcare that I commission.” 

Sir Richard added: “Devolution allows us to commission at different spatial levels, starting with the city-region level; but to deliver services in an integrated, joined-up way at the family and neighbourhood level. I think the approach we’re taking has got risks attached to it, but it is evidence-based and we’ve built that evidence up through a number of routes over a number of years, and ultimately it needs to leave to a healthier and less dependent population.” 

He said it was important to integrate health and social in the context of the wider array of public services, particularly those addressing the neediest people, and said that the social determinants of ill-health need to be tackled. A population less dependent on expensive public services will ultimately make it easier to close the fiscal gap, he added. 

Ian Williamson, interim chief officer for Greater Manchester health and social care devolution, said: “I have been an accountable chief exec in the NHS for nine years. I now find myself with a true once-in-a-career opportunity.” 

Williamson said he was both “excited and apprehensive” about the scale of the opportunity and the challenges, adding: “Greater Manchester devolution is a huge step for the government and NHS England. Some would say it’s risky – if we don’t succeed, it will make it much harder for others to follow. My job, along with the 37 leaders of the [other] statutory bodies, is to make sure we succeed. 

“Our aim through devolution of health and social care is to ensure the greatest and fastest possible improvement to the health and wellbeing of the 2.7 million people of Greater Manchester. 

“We can achieve things together that we could never achieve separately. Our early priorities in this ‘build-up year’ range from improving primary care access, to a joined-up academic health and science system; from a place-based agreement with public Health England, to mental health and work programmes; from constructive early dialogue with Monitor and the [NHS] Trust Development Authority, to taking on specialist commissioning now.

In a Q&A session following the talks, which also featured ResPublica think tank founder Phillip Blond on the changing role and nature of the state and public services, Four Seasons Health Care chair Ian Smith called events in Greater Manchester “one of the most important steps in the history of the NHS”.

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