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Social care cuts ‘will gnaw away’ at GM integration plans

Senior figures in Greater Manchester have joined the growing chorus warning that the city’s landmark health reforms could be held back by the uncertain state of social care funding.

Sir Howard Bernstein, chief executive of Manchester City Council, told the House of Lords NHS Sustainability Committee hearing that he had already written to health secretary Jeremy Hunt, chancellor Philip Hammond and NHS England chief executive Simon Stevens about the issue.

He said the letter, also signed by Jon Rouse and Lord Peter Smith, the chief officer and chair of the Greater Manchester Health and Social Care (GMHSC) Partnership, “explained the particular challenges we have around social care funding which, unless resolved, will gnaw away at our capability to create the sustainable funding platform we have committed to in the next five years”.

He also called a “settled, stable pact” on social care funding, introduced from next year, was “absolutely pivotal”.

In an unprecedented devolution milestone, Greater Manchester gained power over health and social care in April this year. It has now introduced an ambitious programme of integrated care, based on three pillars: establishing local care organisations, integrating commissioning between the council and the city’s CCGs, and creating a single hospital trust.

However, NHE reported last week that papers from the GMHSC Partnership show concerns that the social care cuts could “undermine” the transformation programme.

In a Communities and Local Government Committee hearing on Monday, Rouse said that the GMHSC Partnership doesn’t know how to close the social care funding gap.

Steve Wilson, executive lead for finance and investment on the GMHSC Partnership board, who also appeared in the hearing, told the peers that the social care funding gap would reach £176m over the next five years. “There’s a real risk in that, because the transformation we’re going to deliver in the next five years is going to be key to that vision in 15 years’ time when we see social care integrated with mental health and physical health,” he said.

However, Wilson added that if social care was protected, it would “enable a strategy” to close the GMHSC Partnership financial gap.

The social care deficit as a whole is predicted to reach £2.6bn by 2020, and the government was fiercely criticised for including no increased funding in last week’s Autumn Statement.

Wilson said that overall, he expected the Greater Manchester model to be adopted elsewhere because it was a model of “working on a place basis” that was “the only real way” of meeting the challenges in the sector.

Sir Howard agreed that reform had to be “place-based, not organisationally based” and delivered by localities instead of nationally.

He added that he was seeking devolution of health education spending to GMHSC Partnership, co-commissioned with Health Education England, to make decisions based on the skills and workforce needed in Greater Manchester.

Nicky O’Conner, chief operations officer at GMHSC Partnership, added that the reforms could be threatened by cuts in health education funding, but that the partnership is establishing a ‘Centre of Excellence’, which will bring together Manchester health services and universities, to mitigate this.

When questioned about the role of regulation for GMHSC Partnership, Sir Howard replied that he was “very comfortable” with the relationship with NHS Improvement so far.

However, he added that in the future, there would be a need to “integrate the functional responsibilities of NHS Improvement” into the transformation plan without “undermining the legitimacy of discharging separate statutory responsibilities”.

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