Health and Social Care devolution has made Greater Manchester “officially the most exciting place in the UK” according to The Guardian in February of this year. This is not only because of the historic decision by NHS England and HM Treasury to transfer responsibility for £6 billion of NHS resource for determination by local partnerships of CCGs, councils, GPs and provider trusts but because it has sparked the biggest shake-up of public services in a place. The shake-up is the most genuinely radical and transformational that I have personally witnessed in my thirty year career in local government.
Greater Manchester has worked well together over the last forty years to secure resources, build infrastructure buy and manage airports and create thousands of jobs. We have the fastest growing economy in the UK and yet 40 per cent of our four-year-olds start school not school ready. We also die about 10 years younger than our peers a few miles down the M6 in Cheshire.
Under the political leadership of my Leader at Wigan Council, Lord Peter Smith and Sir Howard Bernstein, a plan is being developed by Ian Williamson in partnership with clinical leaders such as Sir David Dalton, Mike Deegan, Dr Tracey Vell and Dr Ranjit Gill. The plan outlines how we are prepared to invest in up-front prevention, remodel primary care around neighbourhoods, and assess hospital chains to provide flexibility to cope with complex once in a lifetime specialist surgery. Our Transformation Fund makes it all possible to invest in this sort of radical change.
At long last we are linking health and social care reform with local communities and wider public service reform. For example in Sunshine House in Scholes, Wigan – where Orwell lodged when writing The Road to Wigan Pier leading to the creation of the welfare state – we are linking social care, employment and skills together in a place and supporting residents back to work, to good physical and mental health. Our work also connects people with neighbour and community groups who live alongside them to help minimise the need for expensive ineffective social care.
I’m delighted to say that on the front line in Wigan, it’s really working. Our CCG have used this approach and seen a 30% reduction in unplanned hospital admissions by working proactively with GPs to target specific groups of people at risk of unplanned hospital admission.
GPs, social workers, teachers, hospital staff, police, librarians and many other professions have all been trained in ‘The Deal’, a new asset-based approach to working with residents. As opposed to seeing people as units of need that need to be fixed, The Deal strikes a new psychological contract between citizen and state and encourages a fresh approach to looking at old problems through the new lens of ‘what are you good at and what do you enjoy. How can I help you achieve this?’ As opposed to ‘what appears to be the problem?’
The fact is that 40 per cent of people presenting to GPs have not got medical issues that he or she can resolve.
A high number of frail elderly people are not discharged from hospital because they have nobody to look after them in appropriate, safe housing.
These are not medical issues they are social issues and we need to go back to Orwell to find the answers. Barbara Nettleton, the social entrepreneur who runs Sunshine House is featured on the last pages of The Road to Wigan Pier Revisited (Stephen Armstrong). Barbara is suspicious of people like me; ‘council worthies’ she describes us as. But she is right – “the answer to austerity is out there in the assets in our communities”.
Devo helps us make this all happen at scale and pace.
Donna Hall, CBE CEO Wigan Council and Lead CE for Public Service Reform