Manchester’s health revolution will be a beacon for the rest of the UK

Monday, March 23, 2015

If you are poor and therefore more prone than others to ill-health, the NHS does little to equalise your chances. It is the shocking truth about an institution that sits at the core of our citizenship. A boy raised today in Gorton, east Manchester, can expect to die almost 15 years sooner than his Chelsea-born contemporary. This reality has remained largely unaltered by 67 years of the NHS.

But all this is changing. In Greater Manchester, a health revolution is under way. From April 2016, 600,000 Mancunians – the 20% most at risk of getting sick or being hospitalised – can expect a very different NHS. Instead of 10 minutes, once in a blue moon, with a harassed doctor offering a quick prescription, they will be offered regular, lengthy, one-to-one, personalised primary care to transform their health and their lives. Many currently on a downward spiral into deteriorating lung, heart and diabetic disease, as well as those with obesity-related illness, will enjoy a healthier future.

They will spend less time in hospital, live longer, and be less of a burden on the NHS. Greater Manchester – Dickens’s “Cottonopolis”, home of the industrial revolution – has a fresh, compelling vision of itself. It seeks to be the world’s first devolved city region to concentrate its assets around improving citizens’ health.

In our Reform report, “Letting Go: How English devolution can help solve the NHS care and cash crisis”, out today, we call it “Healthopolis”. This innovative approach is poised to save not only Mancunian lives. It could rescue the NHS from its “care and cash” crisis, caused by services that are inadequate and unaffordable for today’s populations.

The game changer is devolution of the city region’s £6bn health and social care budget, announced last month. George Osborne’s rhetoric may be about a “northern powerhouse” but this drowns out perhaps the greater long-term significance for the NHS. Devolution to Greater Manchester is providing the first opportunity to resolve historic fragmentation of leadership, planning and service delivery in the health service that prevents holistic care to turn around a person’s life. Additionally, thanks to devolution of other powers, “Healthopolis” is also gaining control of other, non-medical ways to improve health, such as housing, transport and job support.

In recent months, we have had unique access to health and council officials as they plan their new, radical approach to health. As one official said: “We want GPs effectively to have two prescriptions pads – one for medical prescriptions and one that can refer patients to supports around work, training, housing and exercise that might offer more long-term solutions than, say, anti-depressants.” Another official explained: “Some 60% to 70% of people on employment support allowance have an underlying mental health condition. One in five has a musculoskeletal condition. Yet traditional employment support fails to connect with the full blend of supports that the NHS can offer. Now we can bring it all together.”

Devolution also tackles the NHS cash crisis. Greater Manchester anticipates that even the most rigorous productivity savings will leave an annual deficit for health and social care of £500m by 2017-18. NHS devolution could halve that figure, thanks to fewer hospital admissions and the benefits of integrating health and social care. Greater Manchester, like the rest of the NHS, will still need extra funding, say managers, but devolution halves the requirement.

The Mancunian initiative may cause alarm among those worried about losing the “national” from the NHS. It will certainly disrupt business as usual. We highlight a host of changes that Greater Manchester seeks to make “Healthopolis” work. It will need new rules about central funding, payment systems, competition, regulation, reconfiguration of NHS buildings and land as well as new approaches to training NHS staff for the roles they will play in expanded community health settings.

We warn that, in exchange for NHS resources and freedoms, devolved regions must be required to deliver clearly defined, better outcomes for patients, as well as better value for taxpayers. Every citizen must continue to enjoy the essential features of the NHS – comprehensive health cover, free at the point of clinical need. There should be guaranteed access to primary care physicians, specialist diagnosis and treatment, public transparency on performance and robust intervention where care is inadequate.

But Greater Manchester’s “Healthopolis” deserves support. It offers a great prize that has eluded not only our health service but healthcare systems across the world. It is a real opportunity to support people’s health, not just make them better for a while when they become sick.

 

theguardian.com