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Keogh: Single commissioning process is ‘the right way forward’

The best way to solve the social care crisis would be by encouraging a single commissioning process whereby NHS trusts and local authorities pool resources and budget.

Speaking to NHE during a visit to Manchester, Professor Sir Bruce Keogh, NHS England’s outgoing national medical director, said the approach he had seen in the city “makes a lot of sense.”

Greater Manchester is currently undergoing a health devolution process – the first in the country – as medical responsibilities are passed down from central government to the Greater Manchester Health and Social Care Partnership.

Jon Rouse, chief officer of the partnership, who spoke to us about its progress last year, told NHE today that the city’s approach to care involved integrating care systems and allowing different services to work with one goal and pooled funding.

“A big thing here was introducing integrated discharge teams in every hospital. Now we have health, social care, voluntary support, community transport – and even housing in some cases – working in a co-located environment and all owning the discharge process,” he said.

“Devolution cements the joint responsibility because we are all part of one governance. In many of our localities, for all intents and purposes, it is single commissioning now with a fully pooled budget.”

Keogh, who is in the process of leaving his top job at NHS England at the end of the year, with a replacement announced this week, also spoke very highly to NHE of the systems he has seen in Manchester.

“All parts of the country are facing increasing demand, more complex patients and a tighter financial environment,” he argued. “What strikes me in Manchester is that the way that local authorities and the NHS are working together to solve problems is exemplary. I think it makes a lot of sense.

“The way that things are done at the moment sometimes makes it very difficult for those delivering the services to keep them joined-up, and it makes it virtually impossible for those receiving the service to navigate what they are hoping to receive.

“So, the joined-up approach that is being espoused in Manchester is the right way forward.”

After the first 18 months of the devolution process Greater Manchester has managed to maintain 92% elective performance, reduce delayed transfers of care and deliver a balanced budget, albeit with help from some one-off measures. It has also launched a major new merger of two large hospital trusts in the city centre.

However, Rouse, responsible for the transition of control from central government to more local institutions, said that despite progress the situation was still “really tough.”

He spoke of the creation of a single operational hub in the borough which would oversee the entire system, including ambulance services. The centre would be equipped with several predictive mechanisms aimed at forecasting a potential crisis and allowing escalation of services before a major event hits.

Top image: Joe Giddens

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