The Labour Group in Stockport is submitting a joint response to the consultation on changes to health and care across Greater Manchester, ‘Healthier Together’. The comments below are the collective, considered view of the 22 elected Labour Councillors on Stockport Metropolitan Borough Council. The proposed changes would have an impact on residents across the Borough.

Change to Healthcare in Greater Manchester

The principles of high standards of care, the nurturing and development of expertise in healthcare professionals, and a commitment to reduce health inequalities (including the prevention of excess deaths) across Stockport and Greater Manchester are supported by the Group. We feel the choice on offer in the Healthier Together Consultation is too limited, and that there must have been options available other than either a 4 specialist or 5 specialist hospital model.  Similarly, more flexible primary care and more integrated health and social care provision are aspirations we support, but there are concerns about how these objectives are implemented and whether their delivery to the standard which the people of Stockport deserve is attainable, in the context of both NHS and Local Authority budgets being reduced.

Changes to Primary Care

We support improved access to GPs and other primary care providers, and agree that same-day, 7 day a week access to primary care services is a good objective which will make healthcare more flexible and respond to the needs of the public. The ability of patients with long-term and multiple conditions to have access to a care plan and have better joined up services in place when they really need them is key.

Where concerns exist is in the delivery of some of the commitments;

– GPs are already under pressure, and having more community-based provision requires both a big rise in their workloads, and for associated primary services, and a substantial investment locally and nationally is needed to allow this to happen

– The £20 million of additional investment earmarked for Primary Care for 2015-16 is welcome, but it remains to be seen whether it is significant enough to manage the increasing demands across the 2.7million people in Greater Manchester

– A Health Select Committee Report by MPs in July 2014 outlined how there are currently a shortage of GPs in training, which is a risk to the sustainability of this model for the future

Joined-up Care

The Labour Group have concerns regarding the progress being made in Stockport towards integrating health and social care;

– Stockport MBC is behind other Local Authorities in Greater Manchester, and almost a decade behind some Local Authorities in other parts of the Country (e.g. Torbay)

– Integrating both primary care and adult social care services will be central to the success of Healthier Together, otherwise a reduction in admissions from those who could have community-based care will not be realised

– No provision at all is currently in place in 3 of the 4 CCG areas in Stockport for integrated health and adult social care, with the hub in Marple and Werneth still to be deemed ‘fully functioning’ by the Local Authority. The Group would therefore request a commitment that no hospital reconfiguration will take place in Greater Manchester until integration has been completed across all areas of our Borough

– The level of legislative and operational change in Adult Care Services in the next 12 – 18 months is going to be unprecedented, with the introduction of the £190million (Greater Manchester) Better Care Fund, the Care Act implemented in 2 phases between now and April 2016, local change proposed by the Council, and the Healthier Together reforms

– There are concerns about the burden this level of change will place on staff and patients over the next couple of years

Changes to Hospital Services

Given the options available within the Healthier Together Programme’s Consultation, the Stockport Labour Group wants Stepping Hill Hospital to be granted specialist status as:

– Stepping Hill is a valued local hospital which serves a substantial population across the Borough who, if services changed, would have reduced accessibility and a need to travel elsewhere in the Region for emergency and high-risk general surgery

– Ensuring Stepping Hill Hospital has specialist status will contribute to isolated parts of southern Greater Manchester having adequate services. Stepping Hill has patients from outside Greater Manchester, namely in parts of East Cheshire and in High Peak, who we feel should have access to quality healthcare services. The total catchment area for the hospital is around 320,000 people in total

– The targets set by Healthier Together for access by residents, both in terms of time travelled by Ambulance and by Public Transport, may not be met by some people affected in the catchment area. There are also concerns about the cost and frequency of public transport links to other parts of Greater Manchester increasing the importance of Stepping Hill Hospital

– There are concerns regarding what happens to inter-dependent services such as anaesthetics, critical care, neonatal and diagnostics if Stepping Hill does not get specialist status. The longer term, unintended consequences of some of the proposals have not been adequately considered

– Should Stepping Hill become a ‘Local General Hospital’, it may struggle to attract and retain the best staff, including access to consultants, and we want Stepping Hill to be able to do this in the future. Local General Hospitals will only have 12 hours a day of consultant cover under the proposals, with specialist ones having 16 hours a day

Out of the stated options, therefore, we would be more broadly supportive of either number 5.1 or 5.4 of regarding the future of hospitals in the Region.

Supplementary Observations

– Some of the claims made regarding the benefits realised, especially in relation to the prevention of more than 1,000 excess deaths over 5 years, need to be substantiated further

– NHS Hospital Trusts competing with one another to get specialist status isn’t the best way of getting stakeholders to work together, in the long-term, to provide the best care for patients which the public deserve

– The Consultation has been conducted primarily over the summer, and has been the statutory minimum allowed for changes of this scale. Both the timing and duration of the Consultation have not been ideal, and it has only attracted a response rate of around 1% across the whole of Greater Manchester to date

– The way the Consultation has been handled, in being driven solely by the NHS, and the lack of real choice between some of the options, has left people from across the political spectrum suspecting that decisions have already been made

– There needs to be full ‘buy-in’ from all relevant Local Authorities, including some neighbouring Greater Manchester, as the Healthier Together Programme can’t be seen in isolation.