Rachel Pugh
A year since Greater Manchester became the first region in England to take control of its £6bn health and social care budget, Jon Rouse is pleased at the progress already made, pointing to figures showing that 62-day cancer waits for Greater Manchester were among the best in the country, referrals to treatment targets are better than the England average and access to mental health services exceeds that of the north and of England as a whole. “I am proud,” he says. “In our first year, we have set up more than 20 programmes – and we are performing better overall in these areas than other parts of the country. It is quite an achievement. The key is to make sure the programmes deliver what we intend.”
As chief officer of the Greater Manchester Health and Social Care Partnership, Rouse is responsible for all the region’s health and social care that previously came under Greater Manchester’s 10 local authorities, 15 NHS trusts and foundation trusts, and 12 clinical commissioning groups. The 37 organisations are pooling their budgets to jointly organise, buy and provide health, care and support services for 2.8 million people across the region.
“Technically what we have in Greater Manchester is delegation,” says Rouse. “But what really matters is what we do. Devolution allows more flexibility on how the budget is allocated.”
Rouse has big ambitions for 2017. He wants to see further reductions in the number of unnecessary hospital admissions, GPs providing quality care to those who really need it through a new focused care programme aimed at the most deprived populations – and he wants to beat national standards on mental health.
But improving the basics are also vital, he says. “Devolution does not, however, mean that poor performance will be tolerated.” Greater Manchester has not met the 95% target for patients to be seen within four hours in A&E over the past 17 months, despite rigorous planning, including reducing hospital occupancies in the run-up to Christmas. The average in England is 85.1%, but Greater Manchester’s worst performing area, Stockport, only reached 70.5% and none of the others even reached the England average, except for Central Manchester (88.9%).
Rouse believes proposals announced this week to reform how urgent care is delivered will change all that. “We need to improve the routine GP service and out-of-hours care, but in return we need the public not to turn up to A&E when they do not need to,” he says. “For that to happen, we need to make it as easy as possible for them to know what the alternatives are. In the past we have not done that.” The plans include an app to inform the public which services are open and how busy they are – and a centralised operational hub in south Manchester, which will coordinate how hospitals respond to demand for urgent care across the region. “We are not downgrading any of our A&Es,” says Rouse. “However, we have designated four of our A&Es as higher acuity hubs.” These, which would treat the sickest patients, are Royal Oldham, Central Manchester, Stockport and Salford Royal.
An acute clinical services strategy is also under way, which aims to standardise and consolidate clinical services. Rouse says all hospitals will continue to provide general services, but would also have specialist roles for particular services. “We want to make sure that each hospital has a distinctive role, playing to its strengths. For example, at present Wigan is renowned for orthopaedics and south Manchester for coronary care,” he says.
Rouse points to the Greater Manchester cancer plan as one of devolution’s top achievements. With the exception of the Christie and Central Manchester University NHS foundation trusts, all the hospitals in Greater Manchester exceeded the 85% standard for patients to receive their first treatment within 62 days.
He admits that delayed discharges from hospital are more problematic, with 312 patients across Greater Manchester clocking up 6,729 days for January 2017 alone. “At the moment we are scrambling and it is not sustainable,” says Rouse. “Every day of every week we are being as creative as possible to find more community capacity.”
With the cumulative social care funding gap in the region predicted to reach £2bn by 2021, what can Rouse do practically to reduce this? He speaks with passion about the region’s new social care plan, launched in February, which aims to provide more support for carers, improve care home standards and encourage more people into social care through a new apprentice scheme. At least 70,000 people across the region are carers for more than 50 hours a week. If even 5% withdrew their support, it would leave an additional 3,500 people suddenly in need of the provision of full-time care from the state.
But in the end it is down to money, he says. “Integration is not the panacea. We need a new settlement in return for the way that social care is administered.” Whether Greater Manchester’s share of the £2bn extra funding announced this month is enough remains to be seen.
What about those who say “Devo Manc” is undemocratic and centralising? Rouse agrees that there was no referendum to introduce it, but he insists that there are benefits: “When something goes wrong in one part of the system, it is owned collectively. We treat it as one NHS and social care.
“Our strongest assets are our communities,” he continues. “Communities have the strength and provide the best solutions to their own problems. You have to facilitate that. I want an end to paternalism and talking shops, and to see the release of the power of the community.” It all sounds a bit Pollyannaish. What does he worry about? “There is the danger that the plans and discussions become disconnected and do not translate into changes at ground level,” Rouse admits. “My measure of success will be what people’s experience of healthcare is and whether it has improved. Devolution is not magic dust.”
Additional reporting by Anna Bawden and Pamela Duncan
CV
Age: 48.
Lives: Altrincham.
Family: Married, two daughters.
Education: Latimer Comprehensive school, Kettering; University of Manchester: law degree; London Metropolitan University: MA urban policy; University of Nottingham: MBA.
Career: 2016 to present: chief officer, Greater Manchester Health and Social Care Partnership; 2013-2016: director general, social care, local government and care partnerships, Department of Health; 2007-2013: chief executive, London Borough of Croydon; 2004-2007: chief executive, the Housing Corporation; 2000-2004: chief executive, Commission for Architecture and the Built Environment; 1998–99: secretary, the government’s Urban Task Force; 1995–98: policy and communications manager, English Partnerships; 1994–95: private secretary to housing minister; 1993–94: policy analyst, Energy Saving Trust;
1992–93: principal policy officer, Ealing borough council.
Interests: Playing clarinet, watching Queens Park Rangers FC away and Altrincham FC at home, family life and planning great holidays.
‘Communities provide the best solutions to their own problems’ | Rachel Pugh
