Cities and Local Government Devolution Bill [HL] — House of Lords, 2016-01-12
Topic: Health
Peter Smith (Labour, Centre-left): My Lords, I also support the amendments moved by the noble Lord, and I thank him for his explanation. When the noble Lords introduced the amendment in the name of the noble Lord, Lord Warner, they obviously had a suspicion about what was going on in Greater Manchester— understandably so. We heard the phrase "postcode lottery" from the previous noble and learned Lord. One reason why Greater Manchester wants to take control of health is that there is a current postcode lottery. The average outcomes for health in Greater Manchester, despite the efforts of Governments of all persuasions since 1948, have remained doggedly subject to that postcode lottery. We want to use the powers that we can use locally to start to do something about it With the permission of your Lordships’ House, I shall try to explain what we are doing in Greater Manchester and why we need not fear. It is only 11 months since we signed the original memorandum of understanding with NHS England to share health. The combined authority has not taken control of health; we share responsibility with our health partners. Our number one achievement is to raise the governance. We have 37 different organisations in Greater Manchester with some responsibility for this agenda. I have the dubious task of chairing the strategic partnership board, but colleagues across the piece are working collectively to achieve an outcome. In our collaboration with NHS England, the regulators are being as sympathetic as possible Already we have seen clinical benefits. We have made sure that every area of Greater Manchester has access to a hub seven days a week so that people can receive medical advice—which was not the case before—and that has continued to expand. We have started to commission collectively more work on public health, recognising that this will be a key to achieving significant change in population health. We set up an organisation called Dementia United, which is going to join all the partners together to look at dementia in terms of acute services, primary care services and social care. In December, we agreed a strategic plan to take us forward for the next few years in Greater Manchester. It complies with all national objectives and reflects the needs of Greater Manchester as a sub-region, but also the localities within Greater Manchester The focus, first, is on prevention. If we can get people not to need healthcare, that is the best way for people, for the health system and for care. We need to make sure that each locality addresses the issues that exist in those 10 areas of Greater Manchester. There is quite wide variation in provision, as one might expect, between GP services in one area and another. We just got those up to the same level and have made a great improvement. With acute care services, again there is huge variation between the outcomes of hospitals in Greater Manchester. We need to improve that, and we need to give better support both in the clinical and the back-office sense. To fund this, apart from the money we get from the Government, we think we can operate more efficiently and effectively by integrating lots of services; that will be important. We are also grateful to the Government for allowing us an initial injection of funding from the transformation fund. Skilled negotiation on our part and obviously the generosity of the Government meant that we got £450 million from that fund. That will kick-start some major changes in Greater Manchester. The benefits will include better clinical outcomes; we have targets on those. We will make sure that children get to school at the age of five in better health and are more ready for school than they are at the moment. We are supporting the elderly so that they can live longer in their own homes This is not just about health, however. If we can start to improve the health of people in Greater Manchester, it will reduce some of the barriers to employment and help us to get more people into work. The next step, obviously, will be better engagement with the public and, crucially, with the staff across both NHS and social care. We are making sure that we have detailed implementation plans, so that this does not become a dusty strategic report—one that is very worthy but stays on the shelf—but is actually implemented. The strategy will make a difference, we believe, to the lives of people in Greater Manchester I should emphasise that, the more I have gone into this, the more I have come to realise that there is no boundary between health and social care. The figures vary, but they say that some 40% of the people who come to see the GP in his surgery are not really seeing him on medical matters but on social matters. For example, they may have housing problems or employment problems, so they are not sleeping at night and need support, and so they come to the doctor for tranquillisers. Some GPs are good at dealing with that; some simply give the tranquillisers. We need to make sure that we start to address the issues that people have and not assume all the time that it must be a medical issue My noble friend Lord Beecham asked what happens to the areas around Greater Manchester. Obviously, that is not determined, although we have already made a decision on acute provision in Greater Manchester that reflects Derbyshire, because, clearly, many in north-west Derbyshire—in Glossop and so on—look to Greater Manchester rather than elsewhere, and so we clearly need to reflect that. However, such areas would need their own locality plan for what they are doing in that area, working together with all the local health and social care partners. There is a need to reflect that some stuff is done at the regional level, some stuff is done at the sub-regional level and some stuff is done at the local level Social care is an important element of this. In some parts of Greater Manchester, under the locality plan the acute hospital will run the social care services. In other areas, such as Wigan, we will have a care organisation to ensure that everyone looks at how we can stop people getting ill—that is our main intention—rather than treating them once they are ill. That will vary slightly in different areas, but we will reflect those different localities We are making good progress and there is great collaboration going on. I thank the Government for the opportunity, and I think we will make a difference.