i Editor's Letter: Dividing up the health of the nation


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The Independent Online

A breathtaking story on today’s cover: Greater Manchester is to become the first English region to run its own NHS and care system, taking control of a £6bn-a-year budget, integrating health and social care. The scale, speed, and radical potential are astonishing. The consequences are unguessable.

This is going to be quick. The budget will be handed over next April, not long to pioneer a new system. The Scottish, Welsh and Northern Irish health services are, of course, already devolved, and health and social care have been (or are being) integrated in each to a greater or lesser extent. Successful integration would ease pressure on hospitals unable to discharge frail patients because of the shortage of community care. It could also free resources to tackle chronic long-term health problems like obesity, diabetes, poor housing, exercise...

Is the determination there, though, to create a model that can work nationally – or is this “cheerio” to the idea of an English NHS? Will it lead to yet another tier of management, not long after the last major reorganisation? Meanwhile, Manchester’s status rises. We’ll hopefully see jobs move there from Whitehall, even if this is not a “northern powerhouse” moment.

One final thought. Social care is means-tested – people are expected to contribute, and if you own assets greater than £23,250 you don’t get help from the state. So in merging a paid-for care system with a health service that’s (largely) free at the point of use, we need to be clear where one ends and the other begins.

This is an extraordinary example of co-operation across the political divide, an offer too good for Manchester leaders to turn down. Beelzebub may live in the detail, and that we don’t yet have.


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