• Outgoing ‘Devo Manc’ leader says there has been little appreciation from regulators for work to improve underlying causes of ill health
  • Jon Rouse said meetings with NHSE have felt like “we have to leave our mission purpose at the door”
  • Accused national leaders of paying too much attention to A&E performance
  • Says he was “shocked” by the lack of empowerment for BME communities in Greater Manchester, after arriving from London

NHS England and government officials pay too much attention to accident and emergency waiting times and fail to encourage local leaders to address the underlying causes of ill health, the outgoing leader of Greater Manchester’s devolution project has said.

Jon Rouse told an event in Manchester yesterday: “The whole of the first chapter of [NHSE’s] Five Year Forward View was dedicated to population health. And yet across the many formal assurance meetings I have led on behalf of Greater Manchester with NHS England, I have not been held to account for population outcomes, [nor] asked about levels of mortality or morbidity.

“When we have walked into that room, it has sometimes felt that we have to leave our mission and purpose at the door. That needs to change, not just for GM, but the whole of the country.”

Mr Rouse, who has been chief officer of Greater Manchester Health and Social Care Partnership since 2016, said the region had chosen to prioritise population health outcomes that required strong collaboration with councils and other agencies, such as improved school readiness and reduced mortality from killer diseases.

He added: “We have concentrated on what we believe matters most and will make the biggest difference for the GM population. This doesn’t mean that we think constitutional waiting time standards aren’t important — they are — for safety, quality and experiential reasons — but they are not the most important goals…

“GM has to strive to do better in meeting the constitutional standards. And government and NHS England need to design a constitutional scorecard that cares as much about mortality and morbidity, as whether people are waiting too long in the A&E waiting room.”

Over the last four years, the region has consistently lagged behind the national average performance against the four-hour A&E target, as well as average performance in the north of England.

Although critical of NHSE, he praised the national body’s chief executive, Sir Simon Stevens, saying the devolution project might have folded without his support. 

Mr Rouse, who has been formally employed by NHSE during his tenure, has been responsible for allocating a unique transformation fund worth £450m. Around £30m of that was directly invested in regional population health programmes, in addition to investments channelled through each borough (which have not yet been quantified).

GMHSCP has said these investments have resulted in positive outcomes. HSJ has seen some statistical evidence of this and is planning to publish some analysis next week.

Mr Rouse, who previously held senior roles at Croydon Council and the Department of Health, is leaving GMHSCP at the end of January for the top officer job at Stoke-on-Trent Council.

As previously reported by HSJ, there have been a number of changes to NHS structures and policy in the last year which have lessened the unique nature of the devolution project.

During his speech, Mr Rouse also outlined various lessons and observations from his time in the post, including;

  • On racial inequality: “Having worked in London for many years, it has been a genuine shock to come to Greater Manchester and experience the lack of empowerment and capacity of some of our [black and minority ethnic] communities in Greater Manchester”. He said there are “amazing organisations” that get “very little help or even much interest from at least some statutory bodies”, and he hopes the region will get “much more serious” about addressing race inequality.
  • On primary care networks, he said NHSE’s draft specifications would cut across many decisions that have already been made in Greater Manchester. He said this could “erode a key principle of devolution which was that NHS England defined the ‘what’ and GM should have freedom to define ‘how’ services are provided”.
  • On transformation funding, he said the region made a “well-intentioned mistake” in asking for the £450m to be so heavily front-loaded, as this meant “there was a pressure to make allocation decisions very rapidly and frankly before some local systems and programmes were ready to spend and spend well”.
  • On integration with local government (several clinical commissioning groups and councils have joint leaders), he said: “Greater Manchester remains the only real example of NHS and local government coming together as a truly equal partnership, where the important decisions are taken together; the only place that has resolved the fracture in the 1948 NHS settlement that separated local health services from local democracy.”
  • On collaboration between NHS organisations: “There is still an understandable tendency to hide behind a sense of fiduciary duty to one’s own organisation rather than what is genuinely in the public interest for Greater Manchester as a whole. And there is real variation in the extent to which individual localities have grasped the once-in-a-generation opportunity of devolution, and the transformation resources that have travelled with it, to bring about radical reform of their models of provision.”

Mr Rouse said his comments were made in a personal capacity, rather than as leader of GMHSCP. You can read a full transcript here.

‘Devo Manc’ leader accuses NHS England of fixating on A&E