Manchester – a good test-bed for health and social care integration

Posted on March 16th, by geoff in CT blog. 2 comments

By Caring Times editor Geoff Hodgson

If Manchester is indeed ‘the belly and guts of the nation’ as George Orwell described it in ‘The Road to Wigan Pier’, then what better place for the first serious trial of an integrated health and social care system?

Since the announcement in late February that Manchester is to become the first English region to run its own £6bn health and social care budget, the scheme has already attracted a wodge of big-hitting nay-sayers. To the fore is shadow health secretary Andy Burnham, the MP for the Greater Manchester seat of Leigh and frontrunner to succeed Ed Miliband, who warns that the plans could lead to a “Swiss-cheese NHS”. “Lancashire Crumbly” may be a good local cheesy metaphor for the present condition of the NHS.

But how else is it ever going to happen? The great and the good have been banging on about the need for ‘joined-up services’ for years and it is patently clear that the NHS has not evolved to effectively respond to the demands of a complex modern society. It cannot match the capabilities of modern medicine and is no longer fit for purpose. Let’s see how Manchester gets on – it could be a significant step towards a brave new world.

Richard Humphries, assistant director of policy at The King’s Fund, has said Manchester was chosen because of the strength of local relationships. Let’s hope the belly and guts of the nation doesn’t find health and social care integration too difficult to digest.

  • The CT Blog is written in a personal capacity – comments and opinions expressed are not necessarily endorsed or supported by Caring Times.

2 responses to “Manchester – a good test-bed for health and social care integration”

  1. I can’t see that integration is going to be achieved by exhortation or fiat – as Richard has also noted, there has been almost 70 years’ worth of separate organisational trajectories, and you don’t change the resulting cultures overnight. But we also know from the Systems Leadership work that local commitment to shared ambitions in a specific place, and honest relationships, can go a long way towards overcoming (acknowledged) cultural and other barriers. If these are in place across Greater Manchester, they offer the best hope of real progress, whatever the structures and powers in place.

  2. Gillian Dalley says:

    Sadly there may, as suggested, be a need for structures and powers AND cultural and other barriers to be challenged and changed AND budgets to be ‘pooled’ or shared, but as long as social care is means tested no true integration (presumably one of the chief goals of DevoManc) can ever be achieved. A shared budget can’t ever be a genuinely integrated budget if one end of the scale is ill-defined and un-demarcated – i.e. always able to leech into the bank accounts of self-funders. Self-funders of social care will always be at a disadvantage and collectively be prey to raids from the statutory services. They will always, naturally, try to seek NHS care to avoid having to pay themselves, while local authorities will always see them as the potential subsidisers of their continually diminishing budgets. And politicians will continue to avoid facing up to the implications of true integration – either stop means testing social care OR start means testing the NHS. As a society we have failed for too long to face the moral challenge of providing free-at-the-point-of-use care, both health and social, for all citizens (paid for fairly out of justly applied general taxation). If we don’t do that, we might as well just rub along with the current arrangements, ironing out anomalies where we can, applying rules as fairly as possible but recognising the truth that we can do little more than that. Moreover we need to think seriously about some of the impediments towards joint working that are rarely recognised in all the rhetorical calls for integration – differences in professional ideology, reputational standing, knowledge bases, and pay-scales among many others. Getting people to work together in the same location and other ‘good ideas’ may help a bit but they will never really resolve some of the fundamental and intractable ‘big issue’ differences that exist.

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