Plans to join up Greater Manchester health and social care budgets are not a “town hall takeover” say NHS and local leaders, plus the rest of today’s news

There’s been plenty of breaking news on our site today about Greater Manchester’s plans to join up health and social care budgets, worth £6bn. Here’s the latest:


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3.50pm Delayed transfers of care are at their highest recorded level according to the latest data from NHS England.

The data for January shows that the number of days patients have been delayed in their discharge from hospital was at the highest it has been over a 12 month period, from 1.4m between February 2013 and January 2014 to 1.6m over the same period to January 2015.

HSJ previously reported that there are Cabinet level meetings between communities and local government secretary Eric Pickles and minister for government policy Oliver Letwin and health secretary Jeremy Hunt looking at the pressure on emergency departments and with a particular focus on DTOCs.

The Department of Health has given £35m to local authorities to spend on re-ablement or intermediate care packages as well as home-based care.

3.24pm The British Geriatrics Society has today called on political parties to focus on six key issues in older people’s care, both in the upcoming General Election and as part of a post-election Government.
The BGS identifies six key decisions around health and social care for older people, explaining why politicians and political parties must urgently address each of them, and highlighting the risks of inaction.
The document also outlines how positive decision-making, supported by the insight and expertise of BGS members and healthcare professionals, can provide solutions to some of the most complex and urgent challenges facing the NHS.
The six policy decisions include ending the divide between health and social care, building capacity in Intermediate Care, and providing national strategic direction on older people living with frailty, dementia, complex needs and multiple long-term conditions.

President of the British Geriatrics Society David Oliver said: “Choosing the right health and social care policies for older people is one of the biggest challenges facing politicians today.

“As the largest group of NHS service users, older people hold the key to the future of the health and social care system: getting things right for them will have far-reaching ramifications for patients of all ages, and for the staff and volunteers who care for them.
“The British Geriatrics Society, as the only medical society specialising in the care of older people, has a crucial role to play in this, providing expert insight and guidance based on our members’ front-line experience and leadership across the healthcare spectrum.
Our call to action is essential reading for anyone with an interest in caring for older people, which should be every single one of us.” 

3.22pm In response to the announcement that NHS and Manchester leaders plan to join up health and social care budgets worth £6bn, Janet Morrison, chief executive of the charity Independent Age, said: “We welcome this pioneering move. 

“Older people are the greatest users of the NHS and social care services, so a key test of proposals in Manchester will be whether they improve the quality of health and care services for older people in the city.

“We should not underestimate the challenge. Health and care have different funding models – one is free, the other is means tested.

“The difficulties of the Better Care Fund, which aims to develop much smaller joint health and care schemes, shows that the route to integration is not easy and the proposal is going ahead at a time when pressure on NHS and social care budgets has never been greater. So it will be crucial to see fully-costed, detailed plans on how the new system will work in practice.”

3.21pm The Daily Mail reports that a recruitment consultant created fake references for foreign doctors in a ‘potentially dangerous’ scam to secure them locum jobs at British hospitals.

Seven locum doctors were employed by United Lincolnshire Hospitals NHS Trust and Western Sussex Hospitals NHS Trust on the basis of Ross Etherson’s misleading documents, a court heard.

3.16pm Greater Manchester’s £6bn devolution deal has been criticised for excluding GPs from consultation about the new arrangements.

A memorandum of understanding was today signed by 15 NHS providers, 10 local authorities, NHS England, the chancellor and the health secretary to join up health and social care budgets in Greater Manchester, under the authority of a new strategic health and social care partnership board.

The plans received letters of support from Greater Manchester’s acute trusts, foundation trusts and North West Ambulance Service, but it is understood that GPs, outside of the GP led commissioning bodies, were not involved in involved in discussions

2.43pm Monitor is to review the finances of Basildon and Thurrock University Hospitals Foundation Trust, after an investigation by the regulator found ‘shortcomings’ in the trust’s financial management.

Monitor opened an investigation into the deterioration of finances at the trust in December.

The investigation found Basildon was in breach of its licence to provide healthcare services on a sustainable basis. The trust was predicting a £20m deficit for 2014-15, and did not have a realistic recovery plan, the investigation found.

2.06pm NHS providers across Greater Manchester have called for a ‘new set of relationships’ with health regulators to underpin the newly agreed £6bn devolution of commissioning responsibilities to the conurbation.

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”.

12.26pm Simon Allport, North West Senior Partner at EY, comments on the signing of Greater Manchester’s NHS devolution deal today: “The signing of this agreement is a huge step for the NHS in Manchester and England as a whole.

“It’s now down to Greater Manchester’s 10 councils, 12 Clinical Commissioning Groups and NHS England to design how the new system will look, and work up plans for spending right across the health and social care economy in the city region.

“These plans will need to be closely aligned with the NHS Five Year Forward View and, despite the stated £6bn budget for Greater Manchester, may need to tackle an existing structural deficit.

“There’s a huge amount of work to do against potentially ambitious timescales. However, in recent years the Greater Manchester Combined Authority has successfully adopted a collaborative approach in delivering plans and governance.

“This deal represents an opportunity for the city to make important decisions from a base of local leadership – potentially driving integration, innovation and improvement. If it’s successful, Manchester could create a formula for the rest of England’s regions to emulate.”

12.18pm There has been another maternal death at Homerton University Hospital Foundation Trust.

The hospital has now had five maternal deaths in 18 months.

The death, which occurred in January, has been referred to the coroner and will be investigated as a serious incident by the trust alongside external clinicians - a consultant obstetrician, a consultant anaesthetist and a senior midwife.

12.16pm Clinical Commissioning Groups’ progress on developing plans set out in the Five year forward view will be judged against a new set of “core metrics”, health secretary Jeremy Hunt has said.

Mr Hunt told the Nuffield Trust’s annual summit “more scientific rigour in terms of assessing the quality of commissioning throughout the country is going to be a critical next step”.   

He said: “We will make sure that every CCG, including in Manchester, is reporting on their progress on the Five year forward view on the same set of metrics that matter to patients everywhere.

11.38am The chancellor has said the signing of the £6bn deal to bring together health and social care budgets in Greater Manchester, overseen by an elected mayor, has ‘set a trail for the rest of the country to follow’.

George Osborne spoke to HSJ’s sister title Local Government Chronicle after he signed a memorandum of understanding, leaked in draft form two days ago, with the city’s 10 councils, 12 clinical commissioning groups, 15 NHS providers, NHS England and health secretary Jeremy Hunt.

It will establish a new strategic health and social care partnership board to coordinate health and care planning across a population of around 3 million.

11.06am Monitor has opened an investigation on behalf of patients in Cheshire to look into the finances of Warrington and Halton Hospitals Foundation Trust.

The regulator’s investigation will seek to understand why the trust’s finances have deteriorated and whether it has a credible plan to improve them.

It will also examine how the trust, which runs health care services in Warrington, Runcorn, Widnes and the surrounding areas, is working with other local NHS bodies to address its problems.

Paul Chandler, regional director at Monitor, said: “Patients in Cheshire rely on their local hospitals and we want to make sure that Warrington and Halton Hospitals can continue to provide quality care while effectively managing its finances.

“We want to find out why the trust’s finances have deteriorated and what can be done to fix them.”

Monitor will announce the outcome of its investigation, and whether any regulatory action is needed, in due course.

10.27am Jon Restell, chief executive of the Managers in Partnership trade union tweets:

9.43am Former health secretary Stephen Dorrell told HSJ yesterday, before the full details had been disclosed, he did not think the Manchester deal would require a major structural reorganisation.  

He said: “My view is that it’s an evolution. It grows out of local initiatives that have been going on in Manchester for some time, starting under the last government, to strengthen local engagement in decisions about the shape of local services not just in the health service.  

“There is a determination both on behalf of the local government and the central government organisations that this will happen by evolution. That does not mean that institutions will never change again.

“What it means is that they change in response to the function. Form follows function, rather than trying to impose the same form on the country nationwide.”

9.24am NHS and local government leaders have this morning announced plans to join up health and social care budgets for Manchester worth £6bn – but insisted the deal is not a “town hall takeover” of health services.

A memorandum of understanding, which was leaked in draft form two days ago, has now been signed by 12 clinical commissioning groups, 15 NHS providers, 10 councils, NHS England, the chancellor George Osborne and health secretary Jeremy Hunt.

It will establish a new statutory strategic health and social care partnership board to coordinate health and care planning across a population of around 3 million.

The agreement covers the entire health and social care system in Greater Manchester, including primary care and social care, mental health, acute and community services, and public health.

Full details of the deal are yet to emerge. The draft deal said that the Greater Manchester Combined Authority would lead the regulation of health and care services locally, and would be included in the vanguard of new care models being trialed in the NHS from this year. This morning it still remains to be seen whether these provisions have been included in the final version.

9.09am David Paine, senior reporter at HSJ’s sister publication Local Government Chronicle, is at the press conference. He tweets:

9.05am The ‘top table’:

9.03am As HSJ reported on Wednesday, according to the memorandum of understanding, the health devolution model will be built on the “principle of subsidiarity…ensuring that decisions are made at the lowest level possible”.

8.55am Susan Long, CEO of Bolton Clinical Commissioning Group, at this morning press conference in central Manchester, tweets:

8.53am Leonora Merry from the Nuffield Trust tweets:

8.49am Chancellor George Osborne said: “Today’s agreement with the council leaders of Greater Manchester and NHS England is a major step forward in our plans to build a Northern Powerhouse.

“When I signed the deal with local councils here to devolve more power to Greater Manchester and to create a new elected mayor, I always hoped that a bigger say over healthcare would be part of the package.

“Things have happened even more swiftly than we had all hoped at the time, and now we have a landmark agreement to bring the local NHS and social care much more closely together.

“I am excited about all this because not only does it mean the people of Greater Manchester having more control over the decisions that affect their lives; I believe it will also lead to better, much more joined up health care.

“For example, it should mean more people leaving hospital sooner, and others avoiding having to go to hospital altogether. This is just the start of the journey‎.”

8.45am Ann Barnes, Stockport Foundation Trust chief executive said: “This is an important and exciting development for Greater Manchester. It is not about increasing power, but about increasing the health and prosperity of local people.

“Devolution offers a fantastic opportunity to grow and develop together, not least in respect of health and social care.  We’re starting from a strong place as a number of excellent processes for working collaboratively across the area are already in place.

“We will have greater opportunities to respond swiftly and effectively to the needs of residents and really transform services for them. They will have a powerful voice in a powerful partnership”.

8.42am Lord Peter Smith, chair of Greater Manchester Combined Authority said: “I want to make absolutely clear that this is not, as it has been wrongly portrayed in some quarters, a town hall takeover of Greater Manchester’s NHS budget.

“We will be working together with our NHS colleagues in the region to make joint decisions which reflect local priorities. Ultimately this will be via a new strategic health and social care partnership board.

“This is about decisions about Greater Manchester being taken in Greater Manchester in an integrated way, not being taken away from experts.”

8.37am In a statement released this morning NHS England chief executive Simon Stevens said of the Greater Manchester plan: “Strong and aligned local leadership in Greater Manchester means that now is the time for courage and for bold moves to deliver the ambitious agenda set out in the NHS Five Year Forward View.

“Today’s landmark agreement between NHS England, the local NHS and local government leaders charts a path to the greatest integration and devolution of care funding since the creation of the NHS in 1948.

“While continuing to deliver on national care standards and the patient rights set out in the NHS Constitution, Greater Manchester now has a unique opportunity for innovation and improvement in health and wellbeing. The eyes of the country will now be on what this new partnership can deliver, and today the work begins.”

8.27am: An announcement about plans for Greater Manchester to take control of £6bn of health and social care spending, as reported by HSJ on Wednesday, is expected to start at 8.30am.

David Paine, senior reporter on HSJ’s sister title Local Government Chronicle is at the press event in Manchester. Jeremy Hunt, Simon Stevens and George Osborne are all expectedto speak there.

7.00am: Good morning and welcome to HSJ Live. We start with this comment piece by Lesley Wye and James Rooney who offer advice on the use of management consultants in the NHS.

Manchester NHS calls for regulation shake-up after devolution deal