Greater Manchester is in line to be the first English region to gain full control of its NHS budget, which will be managed by local councils and health groups from April 2016. Under the plan, health and social care are to be better integrated, theoretically easing pressure on hospitals and improving home care services.
What is proposed for Manchester is consistent with what many commentators have been arguing: if we are to respond to the healthcare needs of our communities, health and social care have to be integrated so that care is holistic, makes the best possible use of resources and ensures that the right care is given in the right place.
The idea is that the best people to plan care are those closest to the patients – local professionals familiar with the local context. With one service, the needs of (for example) older people with a chronic illness, can be met in the community by social and health carers, rather than them being detained in hospitals unnecessarily.
But this revolution, devolving the £6 billion health budget to the local authority, is a big risk as well as being a big opportunity. It could mean much better care at less cost for the people of Manchester or it could mean worse care with all the additional costs of reorganisation.
Creating a new culture
What will make the difference is whether the leaders of the initiative – the councils and health groups – recognise that success depends on the culture of the care organisation they create. They have to ensure they create a clear vision for the organisation and everyone involved in it: a relentless determination to deliver high quality, continually improving and compassionate care to the people of Manchester.
That vision should be simple enough to put everyone on one page so everyone in the organisation understands, shares and works consistently with the same values and priorities. And every team, department, directorate and individual in the organisation has to have a small number of clear objectives (no more than five or six) aligned to that vision.
Staff will need to be managed in an effective and enlightened way – it is an indictment of the existing system that nurses are the second most stressed group in the UK working population. That means leaders being supportive, positive, enabling, listening and participative – involving staff in decision making, sharing information and ensuring they are engaging with staff effectively. It means ensuring good management is put in place in the form of helpful appraisals, good training and employee engagement – and that these factors are continually improving throughout the organisation.
A commitment to continual improvement, learning and innovation is vital. Everyone should have, as key objectives, improving the quality of what they do and developing new and improved ways of delivering patient/service user care.
It means (within sensible limits) seeing errors as opportunities for learning and resisting the creeping poison of blame cultures that have damaged the NHS so much.
Moving away from command and control
The new organisation must be built around effective team working, both within teams and with others. Team work is a key predictor of patient mortality in the NHS and teams and directorates working across boundaries in a co-operative and supportive way will be fundamental the success of this organisation. Every team should have improving the effectiveness with which they work with other parts of the organisation as one of its five or six annual objectives, to ensure the delivery of high quality care.
The organisation must embody collective leadership. Leaders have to listen to and empower frontline staff and move away from the dysfunctional and punitive command and control approaches that have plagued both NHS and local authority organisations.
Fundamental, too, will be the extent to which leaders co-operate with each other across the system and make overall care of the people of Manchester their priority, not just their individual or immediate team’s success.
National bodies overseeing the provision of care in Manchester must play their part too, supporting, appreciating and enabling – particularly in the early days of this bold venture. If they are too quick to interfere, too focused on intrusive inspection and too intolerant of innovation, it will create a toxic and low innovation culture. Exactly the opposite of what is needed.
If any of these elements are absent, the Manchester devolution revolution is likely to be a failure with real costs to the health and well-being of the people of Manchester. With them all in place, the Manchester model could become a solution to many of the problems of the National Health Service that confront the country as a whole.