Breakfast Seminar

The health and social care integration agenda was at the heart of Greater Manchester’s ambition to turn around its population’s quality of life, Eamonn Boylan told delegates. Although the Greater Manchester Combined Authority area was made up of ten local authorities, the fact that Manchester Airports Group was now the UK’s third largest carrier of passengers was proof of what this sort of integration could achieve, he pointed out. 

The region had carried out a “genuinely independent” economic review some years ago, he said, the findings of which were “very, very challenging”. The review identified a huge number of people who were of working age but not economically active – the long-term sick. “Manchester is viewed from a distance as very, very successful economically, but health issues are having a huge impact on our economy,” he said. Levels of spend on welfare remained “stubbornly high”, with the region a “net importer of public spend” of more than £5bn a year.

“Our solution to that problem is that you can get much better value for the public spend, but only if you stop arguing with the government about silos and adopt a place-based agenda instead,” he stated. Greater Manchester’s agenda was based on two pillars – economic growth and reform, particularly of public services. However, that also had to be about delivering better outcomes for people, he stressed – the region had a 13-year gap in morbidity between its least-deprived and most-deprived areas, separated “by a distance of about two miles”.

The responsibility for the region’s £6bn health and social care budget had now fully transferred to Greater Manchester, with the region working closely with the Department of Health to try to design a new and integrated approach to health and social care delivery. “That’s easy to say, less easy to do. We’ve had to not only invent new structures, but try to fundamentally change behaviours as well. Our ambition is to move to a basis of commissioning that’s about outcomes, rather than just measuring inputs.”

This meant that providers – working collaboratively – now had the responsibility to deliver the best possible outcomes, he stressed, with the region working hard to develop local and area-wide commissioning frameworks, as well as a single provider entity for foundation trusts and acute providers. “This is all a massive change in the way services are managed, and the challenge isn’t just in Greater Manchester. If we’re going to succeed then we need to persuade national entities like NHS England and Monitor that their models also need to change, and persuade the Treasury to back off and allow us to take control.

“We know what we have to do to have an impact on emergency services, for example,” he continued. “Most people who pitch up at A&E shouldn’t be there – we need to have people treated effectively, at the point of need.” In the short term, however, the pressure on emergency services was intense, while the pressure on the adult social care budget had greatly exacerbated ‘bed blocking’ problems. “That problem’s not just of capacity, but of integration,” he stressed, and was at its worst in those localities where no integrated care teams had been established. “We need integrated assessment and integrated care, as well as a single patient record that’s available to all professionals – that’s a fundamental IT fix.”

If the area’s hospitals were still the same size a few years from now, “you can say we’ve failed”, he told the seminar. “We need greater investment in the community setting. The care model’s often been ‘see and refer’ – what we’re aiming for is ‘see and treat’. But what I don’t want to do is allow some politician to say, ‘we need fewer doctors, fewer nurses’. We don’t – we just need them to be in the right places.”

The challenge was also to make sure organisations with different priorities were on board, he said. “We’re trying to get to a point where we can agree about what needs to change, and the implications of that.” This would be “incredibly challenging” for staff and could only be done by adopting a common approach to issues such as developing skills.

“The issue for us is about capacity in the social care sector to allow changes in the health sector to take place,” he said. “There is a role for the private sector in that, as well as a massive role for the third sector.

“Most of the rest of the public sector think we’re mad,” he told the conference. “We’re being viewed both nationally and in the regions as a test bed to see if these approaches work. But we can build as many shiny offices as we like – unless we address life opportunities and quality of life, we will fail. It’s quite a daunting place to be, but it’s the place we have to be.”