George Osborne gives his views on the £6bn Manchester devolution deal, Nigel Keohane of the Social Market Foundation on integrating care, plus the rest of today’s news and comment

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4.47pm More on Manchester: Mark Horncastle, healthcare expert at PA Consulting, say the role of the Manchester mayor will be key to the success of the NHS devolution deal.

“The new mayor will need a remit and a directive to drive change that will be more significant for local democracy in England than the creation of the London mayoralty.

“If successful, this will be the most transformational change in local government and health services in a generation.”

4.39pm Some late reaction on the Manchester Devo deal from King’s Fund assistant director of policy Richard Humphries.

“‘The news that Greater Manchester’s local authorities and NHS are close to agreeing a deal with NHS England to establish a new partnership for health and social care across the Manchester region is very significant.

“If implemented effectively, this could be a step towards a big prize - a single, seamless health and social care system delivering integrated care for people in Greater Manchester.

“It also provides an opportunity for councils and the NHS to work together to improve health and well -being in the region.

“Manchester has been chosen to test out this new way of working because of the strength of local relationships. It is unlikely that many other areas are yet in a position to follow its lead.”

3.36pm The National Health Action Party has condemned the plan to devolve £6bn of NHS cash to local authorities in Greater Manchester

Its co-leader Dr Clive Peedell said: “there is no mandate for this fundamental change from a national to a local health service.

“Running a multi-billion pound health budget is a massive task which inevitably end up being outsourced like much of local authority provision. Social care is already mostly privatised and merging with health care at a local level will likely result in further privatisation, means-testing and charging, with more NHS money diverted to private companies.”

3pm: We’ve now six stories identifying the key elements of the £6bn Manchester devolution deal and reaction from NHS leaders and politicians. Thanks for bearing with us.

3.06pm Complex questions of governance and accountability will have to be resolved over the coming year to allow the proposed full delegation of primary care and specialised commissioning budgets to Greater Manchester by April 2016

A joint statement from the government, NHS England, and the conurbation’s local authorities and NHS organisations this morning confirmed that they hoped “a full agreement will be reached shortly around partnership working in Greater Manchester on health and social care”.

For the full story, see here.

3pm: The Greater Manchester area will be a ‘trailblazer’ for developing new models of care, and will be one of the first places to access two national transformation funds worth a combined £450m.

A draft memorandum of understanding drawn up by 10 local councils, 12 clinical commissioning groups, the Treasury and NHS England also suggests a local property company is set up to support the redevelopment of care facilities across the conurbation.

The agreement references the NHS Five Year Forward View, which suggests a limited number of new integrated care models that should be introduced across the NHS. NHS England is currently assessing expressions of interest from areas hoping to be included in the “vanguard” of early adopters.

2.52pm Professor of health policy and management at Manchester Business School Kieran Walshe has expressed some scepticisms about £6bn devo plan on twitter:

2.42pm Members of the Royal College of Midwives have voted in favour of accepting the pay offer for NHS staff that was negotiated last month.

The RCM has been consulting with members in England for three weeks. The results are:

·        93.9 per cent voted in favour of accepting the offer

·        6.1 per cent voted in favour of rejecting the offer

·        44.5 per cent of members voted in the consultation

The offer includes a consolidated 1 per cent payment for all staff up to Band 8B; an additional £200 consolidated payment for lower paid staff ; the first point on the pay scale to be abolished, the second raised to £15,100; and a commitment from the government to the NHS Pay Review Body that it will continue to make future recommendations on pay uplift for NHS staff in 2016/17 and thereafter.

2.37pm Greater Manchester has staked a claim to regulate local providers, under new plans to devolve sweeping powers over health and social care services to the region.

The radical proposal is outlined in a draft memorandum of understanding between NHS England and the conurbation’s local authorities and clinical commissioning groups, obtained by HSJ, which if enacted would see the region taking control of £6bn of health and social care spending.

The memorandum lists a number of goals which NHS England has said it is committed to working with Greater Manchester’s councils and CCGs to achieve.

For the full story, see here.

2.25pm Nuffield Trust chief executive Nigel Edwards has responded to the Manchester devolution deal:

“This is an interesting and much-needed experiment to see how joining together health and social care services might work on a large scale.

“It is a real achievement that the various public bodies in Manchester have reached this level of consensus about providing services in the future for their population. We look forward to exploring it in more detail.

 “We know that joining budgets alone is not enough and there needs to be a fundamental shift in mindset and service delivery models to make change real for patients and service users.

“Local leaders in Manchester will find that there is a tension between the ‘N’ in NHS and local decision-making. Experience with the NHS in Wales illustrates how politicised this can get, as responsibility for difficult and often highly contentious decisions is transferred away from Westminster.”

2.20pm Labour London Assembly member Tom Copley asks whether an NHS Devo deal in the capital

2.16pm Shadow secretary Andy Burnham has given a fuller response to the Manchester devolution deal in an interview with the BBC.

He said the “principle behind the devolution plans is a good one” but that it “sounds like another reorganisation” and he raised concerns about different areas getting different powers and freedoms.

Speaking to the BBC: “So yes, in principle [this is a good idea], but this isn’t the way I would do it.

“And I think there are a couple of problems with what they are proposing. First is that this sounds like yet another reorganisation. Now I have said I would work through the organisations I inherit, the ones that were created by the last reorganisation.

“As I understand it, this one will create a new layer in the NHS at Greater Manchester level, and I am not sure that’s the right thing to do.”

1.01pm Data sharing biggest barrier to £6bn Manchester devolution deal, senior officials tell HSJ correspondent James Illman.



12.41pm: We’ve posted out story on the Manchester deal with some exclusive details on the milestones which a deal document expects to be met before the city’s authorities take control of £6bn of NHS cash.

See here for our full story.


12.23pm The Health Foundation’s Tim Gardner offers this view on the £6bn Manchester devolution deal.


11.59am Official response from NHS England and Manchester Councils on £6bn devolution deal has just been released.

This confirms that the 10 local authorities, 12 Clinical Commissioning Groups, 14 NHS partners, NHS England and the government are in discussions on a “groundbreaking agreement” for health and social care.

“This is about creating joint decision-making on an integrated care approach - which recognises the link between physical, mental and social wellbeing,” the statement says.

Simon Stevens, chief executive of NHS England, said: “NHS England is working on this groundbreaking offer to the local NHS in Greater Manchester and elected local authorities because we want to back local leaders and communities who come together to improve the health and care of their residents and patients.”

Dr Hamish Stedman, chair of Salford Clinical Commissioning Group, said: “This is genuine opportunity to enhance health outcomes for the people of Greater Manchester by aligning health and social care and public sector reform.

“Treating a person as a whole - rather than by separate conditions - is designed to bring long-term benefits and independence.”

Lord Peter Smith, chair of Greater Manchester Combined Authority, said: “By ensuring that decisions about health for Greater Manchester are taken in Greater Manchester, we can ensure we have a system specifically tailored to the needs of people in our area.”

Chancellor George Osborne said: “This is exactly what we want to see more of in our health care.  It’s also about giving Greater Manchester more control over things run in Greater Manchester – which is what our vision of a Northern Powerhouse is all about.

“It’s early days, but I think it’s really exciting development.  We’ll be working hard now with Greater Manchester and NHS England on getting the details right so the arrangements work best for patients.”

Cliff Morris, lead on health for the Greater Manchester Combined Authority said: “Our ambition is clear: To move from being one of the places with the worst health outcomes in the country to becoming one of the best and we believe this could be a huge step towards that goal. By fully integrating health and social care we can focus on preventing illness and promoting well-being across all age groups.”

11.49am Shadow health secretary Andy Burnham has responded to the £6bn Manchester devolution deal on twitter, warning the government’s is ‘swiss cheesing’ the NHS.


11.40am. Health secretary Jeremy Hunt appears to have responded to news of the £6bn devolution deal in this tweet.

11.33am The British Medical Association has responded to news that Manchester Councils will gain control of £6bn NHS budget.

BMA Council chair Dr Mark Porter, said: “Any plans to do so would have to be underpinned by clear funding to ensure that an already dangerously over-stretched NHS budget isn’t used to prop up a woefully underfunded social care budget.

“These wide sweeping changes will affect millions of people.

“We need to look carefully at exactly how they will affect the commissioning and delivery of services, and what the impact on patient care will be. We must also ensure clinicians have a central role in decisions over health care, something which was undermined by the Health and Social Care Act 2012.

 “The NHS has just undergone unprecedented upheaval, there must be no more games with our health service and we need to avoid a situation where the NHS moves from being a national to a local political football.”

11.28am The first clinical commissioning groups to gain control of primary care budgets will use new powers to scale up GP services  and work up the new models of care in the NHS Five Year Forward View’s, they told HSJ.

NHS England last week announced that 64 CCGs had been approved to take on delegated commissioning of primary care in 2015-16. One further group has conditional approval.

Helen Hirst, chief officer for Bradford City and Bradford Districts CCGs, which were both approved, told HSJ they would now have “more flexibility” when redesigning services around the new models of care.

See here for the full story.

11.05am The British Social Attitudes Survey has revealed overwhelming support for the NHS and that a significant minority of the public don’t mind who provides care

British people do not have a strong preference whether NHS-funded hospital treatment is provided by the NHS directly, a private organisation, or a not-for-profit body.

The survey of 2,878 adults in Great Britain commissioned by the charity Health Foundation, and carried out by  NatCen Social Research last year, found that:   

•           89 per cent of adults in Great Britain support a national health system that is tax-funded, free at the point of use and provides comprehensive care for all citizens.

•           43 per cent of those polled do not have a preference for whether their NHS-funded hospital care is provided by the NHS or another provider (e.g. private company or not-for-profit body such as a charity or social enterprise). 39% expressed an active preference for this care to be delivered by the NHS.

•           51 per cent think the NHS often wastes money.

10.03am More on that Manchester story. Details of the deal appear to have emerged in a draft “memorandum of understanding” seen by city’s Manchester Evening News.

According to the MEN, the devolution deal involves the formation of “new board” to take decisions across the Greater Manchester region.

9.44am A major story has broken about an announcement due to be made by the chancellor George Osborne on Friday.

The £6bn health and social care budget for Greater Manchester will be taken over by regional councils under devolved NHS powers, the BBC says.

This will see NHS England hand decision-making for spending on hospitals, GPs surgeries and drop-in centres to local politicians. The plan could come into force from April 2016.

More on this story soon…

7.00am Good morning and welcome to HSJ Live.

We kick off the day with a comment piece from Nigel Keohane, research director of think tank the Social Market Foundation and editor of A Problem Shared? New Perspectives on Integrating Care, discussing the spectrum of opinions on integration.