Essential insight into NHS matters in the North West of England, with a particular focus on the devolution project in Greater Manchester. By Lawrence Dunhill

Copy and paste?

Theresa May has been virtually silent on the NHS since taking power, leaving us guessing how far she’ll bend to support health and social care services over the next four years.

So it’s interesting to learn that a delegation from Number 10 took a trip to Greater Manchester at the end of November – to learn about its transformation work and its transferability to other areas.

Jon Rouse, chief officer of the devolution project, told HSJ there was a “genuine interest” in the new care models being developed in boroughs such as Salford and Stockport, which focus primarily on integrating health and social care services

So all eyes will remain on Greater Manchester as an indicator of where the NHS is heading, and how quickly it can get there.

Destination local government

A further glimpse of that destination comes from an imminent review of clinical commissioning groups in the region, and the potential for CCGs to move within local authority structures.

Tameside has already made progress on this front, with Steven Pleasant now leading the CCG and council, and the review signals a desire to drive these sort of changes right across the region, and within a shorter timescale than we might have imagined.

Simple facts

But while things continue to move at impressive speed, some loud alarm bells are now being rung.

When four senior leaders from Greater Manchester, including Sir Howard Bernstein, appeared before the parliamentary inquiry on NHS sustainability, they repeatedly raised the issue of social care funding, in what seemed very much like a pre-determined strategy.

Mr Rouse repeated much the same mantra when he appeared before a separate parliamentary committee, and then told HSJ that some the region’s £450m transformation fund may be needed to prop up day to day social care services. This is pretty worrying stuff.

In his evidence to the committee, Mr Rouse actually sounded eerily similar to NHS England chief executive Simon Stevens, in terms of his summer offensive over the government’s delivery of the necessary funding to deliver the Five Year Forward View.

Mr Stevens said two of his “five tests” had not really been met by the Treasury, and Mr Rouse argued that only two out of four “planks” for Greater Manchester had been met by NHS England (access to capital investment and the protection of social care services).

We could see this as both men getting their excuses in early, but they are also just stating the simple facts.

It’s true that NHS England and Greater Manchester were both awarded generous spending review settlements in comparison with their peers. But it’s also true that they did not get everything they said they needed.

Will GPs jump on board?

It sounds like the city of Manchester will be the next to set out details of its new model of care, with a procurement process set to be launched in the coming weeks for a single provider for out of hospital services, or “local care organisation”.

This is being designed under the multi-speciality community provider (MCP) model, but it seems likely to be hosted by the city’s new acute trust (created through the merger of Central Manchester University Hospitals FT and University Hospital of South Manchester FT).

A pure MCP is driven by and centred on primary care, so it’s curious that Manchester and Stockport are proceeding under this framework when the contract seems likely to be held by an NHS trust.

But in the absence of a large scale and fully equipped GP provider to host the contract, this seems to be the best option to take. This just leaves a big unanswered question over the readiness of GPs to jump on board.

STP headaches in Liverpool

The STP process is proving to be a headache in Liverpool, which didn’t really need a kick up the backside from NHS England to set out its sustainability plans.

The Healthy Liverpool programme has been several years in the making, and has already set out the city’s plans for organisational mergers and major reconfiguration.

There are strong relationships between the key players, and the local authority have been kept in the loop and supportive of the efforts.

Then the STPs come along, driven of course by NHS England under a Conservative government, and lump Liverpool into the huge Cheshire and Merseyside patch.

The city itself was too small to be its own STP, while the smaller power bases on the outskirts, such as Wirral and St Helens, were not keen to be bit part players in a Liverpool-dominated “city region” STP.

For some reason local authorities seem to have been locked out of the STP discussions completely, and when the plans then got leaked they sparked a hugely negative reaction, largely due to potential downgrades of accident and emergency departments outside Liverpool.

So then Labour-led Liverpool City Council felt the need to oppose the regional STP, issuing a statement “to make it very clear that the proposals within the STP are rejected by the council… the STP is damaging to our health service and undermines any faith we could have in the Government’s ability to invest in a future for the NHS”.

Let’s hope the political gesturing doesn’t get in the way of the good progress being made.

Reverse ferret

Meanwhile, over in Cheshire it took just two weeks for local leaders to buckle under public pressure over the future of Macclesfield’s accident and emergency department.

The published STP document said a downgrading the A&E to an urgent care centre was being considered, but a fortnight later the CCG and other partners were stating their commitment to the existing service.

Whichever way you look at it, something has gone seriously wrong here. Announcing the potential downgrade in the small print of the STP was never the smartest move, but then the subsequent retraction feels like a full on panic move.

There have long been concerns for many years over the sustainability of acute services at Macclesfield, and this is unlikely to be the end of this debate.

Poor care in the North West

The North West looks to be one of the most poorly served regions for care home and domiciliary care provision, according to an analysis by the Trusted Care website.

Judged purely on ratings from the Care Quality Commission, Greater Manchester came out as the second worst area, with Merseyside the sixth worst.

There is an obvious link to be made here with the region’s long-standing problems with delayed discharges and A&E delays.

Test the bed

Some positive news from Lancashire, where the “test bed” programme to introduce new technology into health settings has started working with its first patient.

Dementia patient Eric Sefton, from Poulton, has started using a piece of kit called ‘Speakset’, which allows him to use video conferencing to talk to clinicians or family members through his television, providing a bigger image and better volume than a tablet computer.

There is also an option for a phase two installation of a ‘Philips Motiva’ kit, which allows the patient to monitor their weight, blood pressure, pulse or oxygen levels, which is then automatically sent to clinicians.

Giving evidence to the Lords’ inquiry on the long term sustainability of the NHS this week, Simon Stevens said much will depend on the impact of new technology and innovation. So let’s hope the project with Mr Poulton works, and can be replicated quickly across the region.

The project is led by the Lancashire and Cumbria Innovation Alliance, which involved several organisations, but is hosted by Lancashire Care Foundation Trust.

North by North West takes an in-depth fortnightly look at one of the NHS’s most challenged and innovative regions. There will be a particular focus on the devolution experiment in Greater Manchester, but my scope will also include Merseyside, Lancashire, Cheshire and Cumbria.

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