Cllr Alexander Ganotis, Cllr Wendy Wild, and Cllr Tom McGee.

The Labour Party holds the principles of the NHS dear, and Labour Councillors in Stockport and Greater Manchester are no exception. It was nearby, at Park Hospital in Trafford where Aneurin Bevan announced the launch of the Service in 1948. Given this history, coming changes within the structure and running of the NHS in Manchester and Stockport have generated understandable concern.

The Labour Group in Stockport share the concerns of residents over the future of our health services, and the challenges the health and social care economy faces, particularly in the current funding environment. The below seeks to set out Stockport Labour’s position on Stockport Together, why this approach has been taken, the potential risks and benefits and why have no choice but to take action to secure the future of our Health and Social services given the history of underfunding, particularly in Adult Social Care.

WHY WE CAN’T STAND STILL: A FUNDING CRISIS

The approach Stockport Together is taking has two main drivers. By far the greatest driver, and biggest challenge is addressing the chronic, and growing funding crisis in the Health and Social Care economy.

Whereas NHS England has had its funding protected versus other budgetary areas by recent governments, these have represented less than a freeze in real terms and have not increased to meet growing demographic demands. Furthermore, the NHS is not an island, and the impacts of austerity upon wider health outcomes are well known.

From 2010, Conservative-led governments have imposed searing cuts upon a range of services which impact those who are most vulnerable in health terms. Welfare cuts and sanctions have removed crucial benefits from people with long-term conditions and disabilities. Policies such as the bedroom tax have further impacted those on the very edge of poverty, driving ill-health upwards.

Perhaps most significantly, support grants allocated to Local Authorities – in particular those which serve lower socio-economic areas – have been slashed in recent years and are planned to reach zero in Stockport by 2020. Local Authorities provide a range of services which impact upon health outcomes, from public health functions through to, crucially, Social Care provision.

In combination with the above, an ageing population and increasing costs of care have placed further pressures upon Adult Social Care. As a result, the National Audit Office notes that between 2010-11, and 2015-16, Adult Social Care funding has faced real-terms cut of 37%.

Unsurprisingly, this has placed huge strains upon the National Health Service, as people previously dealt with by Social Care teams across the Greater Manchester area find their way to NHS care instead.

The net impact of the above has therefore been an explosion in the burden upon NHS services. Between June 2013 through to June 2016, the monthly expenditure of Stockport NHS Foundation trust grew from £20.8million to £26million (25%), a pace which far outstrips resources. Subsequently, under current arrangements, we face a shortfall of £120 million in Stockport by 2020 /21.

This comes in the context of further challenges faced locally.

Greater Manchester and Stockport begin from a lower base than others in terms of health outcomes, which stems from the impacts of the industrial revolution through into modern-day factors associated with inequality, employment and lifestyle. In consequence, the Greater Manchester area is facing a crisis of funding in the Health and Social care economy, with a Health and Social Care deficit of £2.1billion, more than a third of its £6bn total budget.

In addition, Stockport faces the demographic challenge of an ageing population which will continue to strain resources. Stockport currently has the oldest population in Greater Manchester, and is on course for 21% of residents to be over 65 by 2020, higher than the national average (19%).

DRIVERS OF CHANGE: IMPROVEMENTS AND OPPORTUNITIES

That said, there is another, more positive driver of Stockport Together’s approach. This has been the desire to bring together a range of policy advancements, including fully integrated health and social care provision, and bringing care commissioning and provision under one organisation. The idea behind these is to allow not just for efficient provision of health and social care, but for the development of joined-up care pathways, patient oriented services, and the adoption of preventative models of healthcare. These developments have long been advocated for by clinicians, care staff, voluntary organisations, and service user groups (including the Kings’ Fund, National Voices Project, BMA and others).

These ideas helped inform ‘Stockport One’, which evolved into Stockport Together, ahead of devolution in Greater Manchester, and ahead of the Sustainability and Transformation Partnerships (STP’s) imposed elsewhere. Stockport Together now brings together a range of Stakeholders (Stockport Foundation Trust, Pennine Care NHS Foundation Trust, Viaduct Health, Stockport CCG and Stockport Council). Their aim is to become a fully integrated Multispecialty Community Provider (MCP) capable of delivering new care models which can deliver the foregoing advancements, alongside financial savings.

In so doing, health and social care stakeholders in Stockport have taken a lead as a ‘bottom up’ response to the challenges facing Health and Social Care.

CAN’T THINGS JUST REMAIN AS THEY ARE?

Given the unlikelihood of a flood of government funding from Westminster in the near term, there is simply no ‘do nothing’ alternative available for the NHS across Manchester and in Stockport. That way lies risks of bankruptcy, the fragmenting of frontline services, and potentially an ending of the NHS as we know it.

The status quo simply cannot continue. Without proactive change, there will be system failure in the near term, opening the door to privatisation, something Labour Councillors both in Stockport and across Greater Manchester are determined to prevent.

Despite this, there is a somewhat understandable perception that the Stockport Together plans have been developed either ‘in secret’ or opaquely as a veil for cuts or worse, privatisation.

Stockport Labour want to clearly state that our involvement in Stockport Together is precisely because we believe this to be the best way to stop the defunding, discrediting and destruction of public healthcare provision available to us.

Although the language is sometimes hard to cut through, the documents on the developing plans are available publicly, at http://www.stockport-together.co.uk/documents-and-publications, and
when plans are finalised Stockport Labour will insist they go forward for full, public consultation.

It is our view that more works needs to be done by Stockport Together in outreach and communications efforts with NHS staff and the public alike – something Stockport Labour will be pressing for. Terminology like ‘new care models’, or even ‘workforce realignment’ in these documents may sound ominous. Indeed there is no point in covering up that there may be jobs lost which come with this change, as a necessary part of the savings which need to be made.

However, Stockport Labour’s position on these changes must be pragmatic, aware of the greater costs and risk of no change, given the chronic underfunding we must rectify. It is our view that the newly devolved powers and the model Stockport Together is building mean that where jobs must be lost- these can be done so in the most rational fashion to preserve services.

For example, until recently, the NHS and Local Authorities often commissioned research into needs assessment which, using different measures, assessed the same needs of the same people in parallel. This is but one example of the wasteful duplication caused by not having a joined up approach to health and social care.

Right now, Stockport Together is putting together eight Integrated Care Teams which can assess service user needs at one point of contact and share information in the development of single care pathways. This reduces burdens upon the service user and can provide a holistic approach to care design while saving money through intervening at the right time and avoiding multiple teams visiting the same address. These teams are already saving resources and improving services at the same time.

This is just one example of how an integrated approach can promote the best health outcomes, through making the correct interventions, in the right care environments before conditions worsen and become more costly. This can be encapsulated by the phrase ‘the right care, right place, right time’, and it is our firm belief this can benefit not only service users, but service providers alongside helping to address the funding crisis.

SUMMARY

In sum, the current funding crisis in Health and Social Care in Stockport is extremely concerning, but does not have to be a scare story.

The control the devolved framework for Greater Manchester provides Local Government with, together with the work of Stockport Together can end the national game of political football with our NHS, and the sacrificing of one area of the Health spending in favour of another.

Stockport Together can allow for an end to a range of false economies and duplications within the system which can help address the funding gap. Together, this can allow for health policymaking to be made in accordance with the best available evidence, rather than the most favourable headlines – putting the patient firmly at the centre of everything we do.

In short, it means sensible, long-term planning in the interests of the NHS is now within our grasp. Given the current challenges and funding environment, we see no path forward for the NHS as we know it without change.

Stockport Labour will continue to place Labour values at the heart of the changes made with Stockport Together and seek to deliver NHS and Social Care fit for the challenges of the 21st century.