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BMA deputy chairman Dr Kailash Chand speech in Manchester at the 'Devo Manc. Good for our health' discussion
Everyone who has seen their GP or been to a hospital recently knows doctors in the NHS are dealing with some huge challenges. A large increase in patients with multiple long term conditions. A changing demographic picture that makes old ways of working less effective. And efficiency savings being required on an unprecedented scale, at an unprecedented speed. Yes, the NHS is one of few public services protected from real-term spending cuts. But the reality is that the NHS, according to NHS England, will have a £30 billion funding gap by the end of this parliament.
This is the environment that patients and doctors find themselves in today. And it is in this context that we need to look at the devolution of health funding in Manchester. So let’s be clear: Our patients are the lifeblood of the NHS. Our patients want integrated, not fragmented care. Our patients want coordinated care, not confusing journeys between different parts of the system.
Devo Manc holds out the promise of meaningful and deep integration within the health service, and between health and social care. This integration has great potential to offer real benefits to patients. In particular, it could help to deliver genuinely patient-centered and genuinely coordinated care. That would be quite a prize for patients in Greater Manchester. But the evidence tells us that delivering this will be tough. Very tough. Complex integration takes time and patience to deliver results. And given the efficiency demands being placed on the health system currently, we might say time is short.
However, Greater Manchester has a few aces up its sleeve. It has a long history of partnership working between local authorities. And, our health services have the scale needed to make a real dent in the things that matter to patients. For example, health inequalities. All those involved in Devo Manc would accept that Greater Manchester has real work to do on reducing health inequalities.
The bottom line is that Greater Manchester has one of the lowest life expectancies in the country. There are big differences in health outcomes between richest and poorest. As well as big differences in health outcomes between Greater Manchester and the rest of England. Thankfully, one of the stated aims of the devolution program is to reduce those health inequalities. The British Medical Association warmly welcomes this focus. And, as you might expect, we keenly look forward to seeing more detail.
We do, of course, have a number of questions about the impact of Devo Manc. I want to look at them in turn. Firstly, the merging of health and social care budgets. The effects of deep cuts in social care funding are seen first-hand by doctors every day. Merging health and social care budgets offers opportunities, but also threats to patient care. Given the financial constraints for all local authorities, we want to see safeguards for the quality and availability of patient care in Greater Manchester.
That’s why the recommendations of the Barker Commission in this area are of such interest. The Barker Commission concluded that health and social care spending should be ring-fenced. This would ensure that essential health spending was not diverted to cover shortfalls in other areas.
In addition, there is continuing uncertainty about the future funding of social care in England. This includes even the fundamental issue of how much the individual should pay of the cost of their own care. Residents need clarity on which services constitute healthcare and which constitute social care. For Greater Manchester, this means an early and open conversation with its residents. The public must understand what they might be expected to pay for personal care now and in the future.
Secondly, the importance of a properly resourced workforce. Any devolution of health spending carries a responsibility to support the local clinical workforce. Put simply, without enough boots on the ground, patients will suffer. And there is no evidence in Greater Manchester that shifting the location care is delivered will reduce the levels of staffing needed.
In fact, a recent report from the National Institute for Health Research on primary care in Greater Manchester said that realistic assessment of workforce needs is key in delivering effective integrated care. We couldn’t agree more. The report also says that introducing innovative new practise models, as Greater Manchester is exploring, requires additional workforce capacity. This, of course, is stating the obvious. But it’s always pleasing to hear it from the experts. It isn’t just about having enough staff to deliver the care patients need, however.
Greater Manchester needs to cooperate closely with Health Education England and other stakeholders on workforce planning. And critically, where new ways of working are explored, the existing terms and conditions of NHS staff must be protected.
Thirdly and finally, the BMA is keen to understand whether the proportion of NHS services in Greater Manchester being delivered by the private sector is likely to increase. As we all know, the social care sector is now dominated by private providers. And as mentioned earlier, pooling health and social care budgets could make it harder to distinguish health spend from social care spend. This could make protecting health spend that much harder.
Nationally, the ability of the NHS to act as a coordinated service continues to be reduced because competition is encouraged between organisations. The BMA believes that the NHS should always be the preferred provider of services. And given the world-leading record of the NHS on quality and cost-efficiency, we would hope Greater Manchester would take the same view.
To me Devo Manc could be seen as a triumph for local democracy, championing the fundamental needs of total healthcare as defined by WHO, or as the creation of yet another false dawn. What I can say is that history is being shaped up in Greater Manchester, and let's hope that we will all look back and say triumphantly - I was there at the time!
Thank you Kailash
In the Southwest Region we are monitoring developments up there closely as Cornwall (as you may know) was mentioned recently by the Chancellor as next; although we have no more information currently.
Chair South West Regional Council