Devo-Manc represents a threat as well as an opportunity for care

22 Mar 16

Attempts to harmonise health and social care across Greater Manchester could usher in a race to the bottom

For all the positive rhetoric that has accompanied Greater Manchester’s devolution around health and social care, it’s difficult to shake off the feeling that it represents as much of a threat as it does an opportunity.

Like many parts of the country, the conurbation has to get to grips with rising demand for services in the face of dwindling resources. From April 1, Greater Manchester will decide how and where its £6bn health and social care budget is spent.

It’s an exciting opportunity and has ushered in a strategy built around prevention, early intervention, greater collaboration and a concerted effort to nurture a greater resilience across our 2.8 million residents. It’s about engaging communities in their health and wellbeing rather than perpetuating a system built around organisations rather than people and which clearly isn’t equipped to deal with the challenges ahead.

So why the cynicism?

To start with, there’s the small matter that along with control over a £6bn budget, Greater Manchester also takes on responsibility for dealing with what is expected to be a £2bn shortfall in funding by 2021.

But more pertinently, when you’re running an organisation providing services that contribute towards these health and wellbeing goals, Greater Manchester’s devolution looks a good deal different on the inside than it does from the outside.

Devolution is a process and it still has a long way to run – we are far from the fully formed package that is sometimes portrayed in the media.

The apparent unity across the area’s 37 NHS organisations and local authorities is not always reflected in the way they work on the ground and residents currently face a postcode lottery when it comes to accessing vital support. My major concern is that in attempting to achieve universality of services across Greater Manchester we will see a race to the bottom rather than an improvement in provision across the board.

The organisation I run, Manchester Care & Repair, is a charity and accredited home improvement agency (HIA) that provides a range of support services to older and disabled people to help them live independently and improve their quality of life. Things like handyperson services to do everything from unblocking sinks to fixing dripping taps, technical support with home adaptations like the installation of wet rooms and stairlifts and offering information and advice on issues like debt, fuel poverty and accessing welfare benefits and grants. We also run a seven-day-a-week hospital discharge scheme in partnership with North Manchester General Hospital so that vulnerable or isolated older patients can access a tailored package of support which helps to smooth the transition from hospital to home, build resilience, aid recuperation and prevent unnecessary readmission.

There are about 200 HIAs across England. Some are run by local authorities, others by housing associations. I believe that the best of them really represent the glue that binds together health, housing and social care. They are on the frontline of prevention and early intervention, providing practical support so that people can manage long-term conditions, reduce their care needs and stay out of hospital.

Across the country there are examples of HIAs like my own, such as Lincolnshire Home Independence Agency, working with partners creatively across local authority and NHS boundaries to enable services to be commissioned differently.

Ultimately, this is the kind of work that will enable the country to meet the needs of an ageing population and keep control of public sector spending.

And yet in Manchester, four of the ten local authority areas do not have any HIA services, some only have very limited provision while others are well served. Local authorities are taking vastly different approaches across the conurbation and if we’re to address these inconsistencies there will need to be a Greater Manchester-wide acceptance that investing in preventative services that maintain people’s independence and wellbeing not only benefits the ageing population but also reduces or delays more costly calls on the budgets of acute or residential services.

Social housing tenants tend to be better served but owner-occupiers and those in the private rented sector too often get a raw deal. Devolution should be seen as an opportunity to tackle this gap head on.

As it stands, it looks like we have curate’s egg devolution – good in parts. It is bringing with it more responsibility at a local level, but not necessarily more certainty.

Janette Linacre will be taking part in a debate about the impact of devolution at the HIA National Conference in Manchester on 20 April

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