Manchester’s £6bn NHS deal sparks ‘queue to be next’

27 Mar 15

The leader of Manchester City Council has said he expects other cities to replicate the landmark agreement for the conurbation’s combined authority to take control of its £6bn NHS budget.

Speaking to Public Finance after the historic deal between the government, councils and the NHS in Manchester, Sir Richard Leese said the reforms provided the basis for improved integration between health and social care.

The ‘ultimate task’ of the integration arrangements, which are set to take effect from April 2016, would be to increase the amount of money spent on preventive medicine, he said.

‘We have to reduce unnecessary admissions to hospital and we need to minimise stays by having proper care packages and support for people in both health and social care.

‘That means that we have to transfer a lot of what we currently do from the acute sector into the primary and community sector. Having the potential to join all of those budgets up gives us a better chance of doing that.’

A memorandum of understanding was signed on February 27 between Greater Manchester’s 10 local authorities, 12 NHS clinical commissioning groups and 15 NHS providers, as well as NHS England chief executive Simon Stevens and Chancellor George Osborne.

Under the plan, a new joint decision- making process for all £6bn of health and social care spending will be developed over the next year. A Greater Manchester Strategic Health and Social Care Partnership Board will be formedto oversee development of the health and care system, while a joint commissioning board will be responsible for financial plans and budget proposals.

An outline business plan, to be published in October, will set out the scope for possible savings through integration, as well as the capital investment needed to deliver the shift from acute care to the primary and community sectors.

Leese, who chairs both the Core Cities Cabinet of England’s eight largest urban areas outside London and the Local Government Association’s city regions board, said Manchester offers a potential template for other areas.

There is ‘a queue of people who want to be next’, he added, and they are learning from the work of Manchester in establishing its combined authority, which was the first in the country when formed in 2011. ‘Other places don’t need to take so long to do it now because they can use our experience as a template to develop their own models, so I think other places will catch up pretty quickly.’

Leese also highlighted the key role of Simon Stevens, who ‘played a significant part in getting us to this point’.

NHS England understood the need for greater local control of provision, he added. ‘I think they recognise that if they are going to deliver their national mandate, which is effectively the what they have to do, they are far better in leaving the how to local partnerships to deliver on their behalf.’

Newcastle City Council leader Nick Forbes, who is also the Core Cities Cabinet member for public sector reform, said the agreement was ‘a trailblazing deal’.

‘The boldness and visionary nature of the deal is terrific, and the Greater Manchester authorities and the CCGs should be congratulated on having such tremendous vision,’ he said.

Forbes added that, although settlements for other cities would need to be bespoke to reflect different patient flows across the country, Manchester’s pact had ‘taken the lid off the box’.

He told PF: ‘The significant thing about the Greater Manchester deal is that it wasn’t just signed up to by the local authorities, it was signed up to enthusiastically by the clinical commissioning groups and NHS England. Getting health, social care and public health onto the same page within the same plan is the kind of thing all of us aspire to.

‘The Manchester settlement is starting to open up a new way of working, and I think NHS England can, and should, accelerate that pace by being more explicit with clinical commissioning groups that they expect to see this level of ambition in other local areas too.'

Responding to the comments, Paul Briddock, the HFMA’s director of policy, told Public Finance that the Manchester devolution plans were a very interesting development.

‘There have been continued calls for greater working between health and social care and the need for different and more integrated service models,’ he added.

‘The Manchester plans provide an opportunity to pilot new integrated care models at scale within an area for the first time. As such should they should be welcomed.

‘However, there are lots of unknowns that need to be clearly worked out as part of this pilot, including the financial implications. Much of this will include the logistics of payment systems, the national tariff and local tariff variations, as well as ensuring value from the public purse.

It will also take time to work out efficient ways forward with governance and accounting rules across the next year. He added that it would also be key to properly measure the results of more integrated working.

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