Sir Richard Leese became chair of the Greater Manchester Health and Social Care Partnership in March 2020, only days before we entered the first national coronavirus lockdown. Below, Sir Richard reflects on the last twelve months, including: the challenges the health and social care system has faced, the lessons we’ve learnt this year, and how the pandemic brought to the fore many of the pre-existing inequalities in our society.

A year on from the nation’s first lockdown, it’s fitting that it’s now – amidst an environment of greater partnership working – we’ve signed off our shared vision for the future hospital site in North Manchester. One that places good health and staying well at the heart of local communities. A hospital site that will lay its new foundations as an anchor institution to create health and wealth – developing a community, not just a collection of buildings. Helping ensure that all communities can prosper and benefit from the advantages that a large employer like the NHS and others can bring. Recognising that work is a health issue is key and something we’ve seen play out throughout the last twelve months.

We know that too many people can’t find work due to ill health and that being out of work often means a person’s health deteriorates further due to stress and financial worries. It becomes a distressing cycle. The pandemic has shown up and down the country how crucial it is that organisations cross traditional boundaries to work together to fulfil a basic social contract between citizen and state. Covid has brought to the forefront many opportunities to advance good practice which already exists in Greater Manchester. Joined up working, often termed integrated working is something we’re good at here. We showed that with Covid through building on our shared history working together. We have both cooperation and accountability. When there is a system-wide commitment to a shared vision, and an ability to join up both the strategic vision and commissioning functions, there are better outcomes for everyone.

We have a chance with the latest government white paper to go further and faster than before.  For that, we need to continue with both prioritising place and our population health approach – where people can look after and improve their own health and wellbeing – and live in good health for longer. We must take a stronger role in addressing inequalities and going beyond a commitment to meaningful change. We must act on this. Marmot shone a light on the social determinants of health ten years ago. Covid has shone this light again on the persistent social inequalities that as a country we haven’t been very good at tackling. Covid exposed just how vulnerable many of our communities in Greater Manchester were to contracting the virus and suffering more from it. This is sadly reflected in the large numbers of lives lost to Covid.

We now need to make choices that take us forward not back and work together across the public, private and voluntary sector to do this. Proportionately greater investments are needed to reduce regional health inequalities. Yet more than that, places need a fair funding model and one that reflects behaviours not just tariffs. Throughout the last year, it has been encouraging to see genuine integration of social care on a level perhaps not seen before. We need to hold on to this. We are better when we work as partners. That said, funding of social care is in desperate need of reform. This is not new. Or even radical. Without a proper long-term financial solution for social care, almost everything else is a sticking plaster. Social care shouldn’t be dependent on one off funding – it needs long-term financial stability.

Since ‘Taking Charge’ was published, we have made big strides in areas like smoking cessation, school readiness, digital health, and cancer services. Covid has and will undoubtedly impact our work. Our activity has been almost completely dominated by Covid. We are looking at recovery and how to ensure we have capacity to catch up and manage new demand. Some of the work we have done on virtual appointments will stay, where this is appropriate – as will being able to book appointments at accident and emergency. We are looking at how we manage demand and services to build back fairer and support people to access the right care, in the right place at the right time.

There is real passion amongst health and care staff and volunteers in Greater Manchester to make the system work better. Of course, there are different views on how this is best. The passion reflects this. What’s striking here is that these differences and challenges aren’t ever really about our core purpose and that commitment to improve people’s health, their lives and life chances. I spend a lot of time talking and meeting people – virtually now – and we are fortunate that we don’t stand still here. We are never satisfied. Creating the right conditions for good health and wellbeing will mean there is always work to do. We will always be on a journey as we learn more about people, as communities change, as there are improvements to technology and treatment and as people live longer with more complex needs.  Form must follow function. I am hopeful about the future and seeing what we can do together.

 

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