Manchester NHS calls for regulation shake-up after devolution deal

NHS England has today signed a memorandum of understanding with Greater Manchester’s NHS commissioners and local authorities to work towards radical delegation and sharing of health and social care commissioning across the area.

In joint letters of support for the plan sent to NHS England chief executive Simon Stevens, the conurbation’s 14 acute, mental health and community providers say that it will require “the development of a new set of relationships with the regulatory and inspection bodies within health and social care, including Monitor, the NHS Trust Development Authority and the Care Quality Commission”.

The letters continue: “It has been proposed that a memorandum of agreement should be developed to define the new relationship. We strongly welcome this proposal and would want to play an important role in developing the agreement.

“The key objective of the agreement must be to create a [Greater Manchester] sub-regional focus for the regulatory and inspection functions, whilst maintaining proper consistency. This will allow the regulators to gain a far clearer understanding of the strategic and transformational agenda in Greater Manchester, and to provide advice and support that facilitates rather than impedes change.”

As HSJ reported earlier this week, a leaked draft of the memorandum of understanding suggested that Greater Manchester’s clinical commissioning groups and local authorities should “lead the regulation of its provider community, with support from Monitor, the TDA and CQC”.

However, that wording has been changed in the final agreement, which now states that the parties will work towards Greater Manchester playing a “clearly defined leadership role in the oversight of its provider community”, in “close partnership” with the regulators.

The document also expresses an intention for Greater Manchester’s commissioners to become “responsible for designing and creating the provider structure and form to support its commissioning intentions” in collaboration with the regulators.

The providers’ letters note that the memorandum focuses on “commissioner responsibilities” and “needs to reflect the devolution of powers and resources from NHS England to [Greater Manchester’s] CCGs and local authorities”.

However, they welcome the inclusion in proposed governance arrangements of a formally established provider forum, and the “centrality of a co-design approach” to the strategic transformation of services.

The letters add that emphasising co-design from the outset will ensure that “whilst there is still an important role for competition between providers” there are “clearer mechanisms for cooperation between providers and with commissioners”.

Central Manchester CCG chief officer Ian Williamson told HSJ: “We are enthusiastically seeking to have a constructive conversation with regulators about how we work best with them in a way that serves the city region, because all of our trusts and FTs have individual bilateral relationships with the TDA or with Monitor.”

He added that the conurbation and NHS England had agreed the principle that, where possible, all decisions about Greater Manchester should be made with Greater Manchester and “that’s the principle we want to agree with regulators as well”.

“Decisions about individual institutions, individual hospitals – increasingly we are going to be asking for those decisions to be made in conjunction with us in Greater Manchester, rather than just with an individual organisation,” he said.