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29 November 2001
Professor Robert Tinston CBE
Regional Director
NHS Executive - North West
Department of Health
Birchwood
Warrington WA7 7BR
Dear Robert,
Consultation on the proposal to establish a new Health Authority for
Greater Manchester
I am pleased to reply on behalf of Social Services North West to your consultation document.
As you know, Social Services North West is the member-level body which represents the local authorities in the North West of England which have responsibility for the personal social services. 19 of the 22 eligible authorities are members. We work with our member local authorities and others to promote high quality services in the North West. We have valued our close working relationship with the NHS, both locally and with yourself and colleagues at regional level. We see Working with the NHS as our top priority issue, and we hope you will find that reflected in our comments below.
Back in the summer of 2001, Social Services North West welcomed the principles underpinning Shifting the Balance of Power in the NHS – Securing Delivery, and its companion which addresses the reform of the Department of Health itself. We particularly welcomed the commitments to supporting delivery at the front line, and to encouraging partnerships in health and local government to ensure integration between health and social care. These are commitments which we share.
We were uneasy about the rapid and radical change which was planned to take place simultaneously at all four levels in the NHS – national, regional, sub-regional and local. We felt this was bound to lead to instability within the leadership and management of the NHS, and to deflect attention from the many demanding targets currently facing the health and social care system. This is indeed proving to be the case as implementation proceeds, but it remains as essential as ever for us all to remain focussed on the need to maintain adequate delivery in the short term, as well as to improve delivery in the longer term.
We welcome the development of Primary Care Trusts and support the three key roles identified for them in the document: Improving the Health of the Community, Securing the Provision of Services, and Integrating Health and Social Care. Our member authorities see the emerging PCTs as their primary partners at local level, and are committed to developing ever closer working relationships between health and social care. Our member authorities are involved in (and often leading) a rapidly increasing number of joint projects using Health Act flexibilities, and joint managerial appointments for key areas of service. We see such voluntary partnerships as key to the successful integration of health and social care at the point of delivery to service users. In this context, we welcome the document's recognition that Care Trusts will have a role "where local partners agree."
In relation to Strategic Health Authorities in general, we accept the case for an organisational tier in the NHS at conurbation/sub-regional level. We also accept the three key roles envisaged for them: Creating a coherent strategic framework, Performance Management of local NHS organisations, and Supporting Improvement. As agreed with your colleagues earlier this year, we look forward to developing a working relationship with the Chairs and Chief Executives of the three Strategic Health Authorities to be established in the North West.
We have reservations about the role of the Regional Directors of Health and Social Care, which as yet is insufficiently defined in relation to the Social Services Inspectorate and autonomous local authorities. We shall watch developments with interest.
In relation to the proposal for a new Health Authority for Greater Manchester, we accept the analysis and the rationale for the preferred option of a single authority for the whole conurbation. Our member authorities in Greater Manchester are used to working at that level for a number of functions. Many of them also welcome the return to a 'one-on one' relationship with their primary NHS partner, now the PCT; although others will now need to relate to more than one PCT.
We accept and welcome the stated implications for patients and the public, and have welcomed the recent strengthening of Ministers' proposals for Involving Patients and the Public. In the section on Implications for Partner Organisations, we welcome the restatement of the basic principles of the NHS, and the recognition of the centrality of the relationship between the NHS and the whole of Local Government.
Our member authorities, and Social Services North West as a body, look forward to further developing our joint work with the NHS, both locally through the PCTs and at the level of the Strategic Health Authorities. In this way, we shall all be able to play our part in further improving the health and wellbeing of the people of the North West.
Yours sincerely,
Councillor Cliff Morris, Chair, Social Services North West
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