Responding to the news that local authorities and health services in Manchester are to enter a new partnership to bring together health and social care budgets, Nuffield Trust Chief Executive Nigel Edwards said:
“This is an interesting and much-needed experiment to see how joining together health and social care services might work on a large scale. It is a real achievement that the various public bodies in Manchester have reached this level of consensus about providing services in the future for their population. We look forward to exploring it in more detail.
Local leaders in Manchester will find that there is a tension between the ‘N’ in NHS and local decision-making. Experience with the NHS in Wales illustrates how politicised this can get, as responsibility for difficult and often highly contentious decisions is transferred away from Westminster.
Nigel Edwards, Chief Executive at the Nuffield Trust
“It is hoped that joining services together on a large scale like this will produce financial savings. But this is a hypothesis. We know that joining budgets alone is not enough and there needs to be a fundamental shift in mindset and service delivery models to make change real for patients and service users.
“Local leaders in Manchester will find that there is a tension between the ‘N’ in NHS and local decision-making. Experience with the NHS in Wales illustrates how politicised this can get, as responsibility for difficult and often highly contentious decisions is transferred away from Westminster.
“These tensions are likely to play out in Manchester in relation to the real challenges relating to the organisation of health services in the area. In particular there is a long-standing recognition that there are too many hospitals, and that closures or downgrades may be needed.
“Local politicians deserve kudos for stepping into the lion’s den where their national counterparts have shied away from tough decisions. But there are some real questions to answer about where the accountability of such an approach will lie.
“Bringing together the budgets of two services under severe pressure will not solve the short-term funding crisis affecting health and social care. Of particular concern is that the money currently available for research, education and training will be siphoned off when the reality bites that frontline services are under pressure."