There has been a mass outbreak of blogging since the BBC leaked the devolution of health budgets to Greater Manchester. As one might expect, a slightly mis-leading headline leads to blogs that are way off the mark but the quality of analysis has improved since more details became public.
Like many of those who have written on the subject I am slightly cynical and have many questions, such as: how does this fit with a National Health Service? As a citizen of Greater Manchester where is the democratic accountability? (the deal does not mention the Mayor at all – not that the Mayor is the answer). Is the timescale too ambitious? How do you join up Local Authorities with a health service that is not currently joined up itself? How do you make a success when so many of the organisations involved are in financial crisis? Where is the capacity to make this happen going to come from given all the organisations are stretched at the moment? Are we simply being used for electioneering? Where is the patient voice in all of this? – ‘No decision about me without me’ has turned into ‘No decision about GM without GM’: without ‘me’ in a backroom deal.
However despite these questions, which must be answered, I think this is an opportunity we have to grab.
When you look at the health outcomes for Manchester we are constantly at the bottom of all the league tables. Despite investment, committed staff and hard work, we constantly fail to deliver in terms of health outcomes for the people of the City.
At South Manchester CCG Board meetings I have regularly made the point that we could have the best hospitals, the greatest GPs and the best community services, but unless we change other factors such as housing, worklessness and poverty we will only marginally effect the health outcomes of our residents. The devolution agenda is one that acknowledges this quandary – and could allow us to start tackling it effectively.
We can only get tough on poor health outcomes when get tough on the causes of poor health outcomes. If we have the opportunity in Greater Manchester to join up the thinking and the spending it is probably too good an opportunity to miss.
As I said at the start, there are many, many questions to answer and one of my roles will be to make the case for the patient voice to be heard throughout the process: and that means embedded from this moment on (something you would expect NHS England to insist on). The deal with the Treasury and NHS England has been done in private, but everything from now on needs to be transparent and in the public domain. I am certain the journey will be much slower than the ambitious timescales outlined in the plan and that will be no bad thing if it means getting the openness right: what is important is the ambition.
I am sure I am going to be writing about this a lot more – but for now I am going to be positive about the opportunity given the current health outcomes in the city, after all, doing the same thing year after year and expecting different results would be insanity, wouldn’t it?