DevoManc anniversary gives little cause for celebration | Andrew Harrop

NHS devolution in Greater Manchester turns one on Saturday, but it is not a birthday many will mark. When the Fabian Society questioned Mancunians for a new report, Local and National, they knew almost nothing about the initiative. Health devolution, it would seem, is happening behind closed doors, decentralisation without democracy.

That seems rather odd to those familiar with the mantras of localism. Devolution is meant to be about bringing power to the people by passing responsibilities to places where there is local transparency, scrutiny and public participation. That is the point of the new metro mayors being introduced in May.

So far, the experiment in Greater Manchester has a different rationale, and the new mayor will only be involved on the margins. It is an attempt to rewire local and regional health economies, by allowing local agencies to work out for themselves how to integrate and reconfigure. This is leading to Greater Manchester councils and the NHS establishing joint commissioning and joint bodies to deliver social care and community healthcare, and embarking on a major reorganisation of hospitals.

The powers and money devolved to the region are important, but so too is the political energy the buzz of devolution has brought to the local public sector. Local leaders are also seeking to align health decisions with their other responsibilities, to ensure each public service promotes good health. This is likely to be where the new mayor comes in, to knock heads together when the temptation is for different agencies to pursue their own paths.

So far this is a purely technocratic, private process. In the 12 months since Greater Manchester was handed new powers, NHS managers, council officials and elected members have been hard at work. But to residents, health devolution is invisible and local MPs and voluntary sector leaders are starting to grumble.

That’s a shame, because the Mancunians we brought together in discussion groups were pretty positive about their city region gaining NHS powers. Many of them saw it as “a coup for Greater Manchester” and all firmly believed that decisions about the city should be made there. They felt that local decision makers understood their communities better and would be easier to hold to account than “some faceless bureaucrat down south”.

But they were concerned about lack of transparency. They understood that experts needed to run complex services like the NHS, but they wanted to be better informed. While they didn’t think residents should call all the shots, one said it mattered that “local people are represented, not just local councils”. She wanted “local people somehow representing different parts of Greater Manchester, or different illnesses … people who’ve got really good local connections, and the skills to have some influence”.

This scepticism about councils was widely shared and will be a significant challenge to the development of health devolution, which is as much about councils getting involved as passing powers down from the centre. Some of the people we spoke to appreciated that councils should be involved in joining up services and preventing ill health. But many felt that councillors did not understand the health service and were poor at communicating with constituents.

They were even more doubtful about whether the new Greater Manchester mayor should influence NHS decisions, although the conversations took place many months before the post comes into being.

The endorsement for devolution we heard in Greater Manchester is not universal. When we spoke to a similar group in Newcastle, they were much more sceptical about the ability of local leaders to do better than national decision makers. They worried about what would happen if the money ran out and said they would rather “wait and see” than follow in Greater Manchester’s footsteps.

But across the country most people think the NHS would do better with more local power. In a Fabian Society/You Gov poll of adults in England, conducted in the autumn, 46% agreed with the statement “if healthcare was managed locally, services in my community would be better”, while only 18% preferred the alternative statement “healthcare is best when national leaders and organisations are in control”. This is the first evidence that there is latent appetite for health localism nationwide.

However, we also found it will only be possible to secure public support for NHS devolution if it happens in a way that avoids the dreaded “postcode lottery”. In the discussions in Greater Manchester and Newcastle, participants refused to accept inequality in standards or entitlements: “Everybody should be entitled to the same level of care, and the same services, regardless.”

And the results from our England-wide survey were just as emphatic. Just 17% preferred the statement “different communities have different needs so healthcare should be different in different places” while 71% chose the alternative, “healthcare should be the same across the country so nobody loses out”.

Localists have been warned. The public is ready to hear arguments that devolution and integration can improve local care. But without guarantees of national consistency, NHS devolution will fail the test of public opinion.

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DevoManc anniversary gives little cause for celebration | Andrew Harrop

Lead to for celebration as NHS is rated the ideal healthcare system | @guardianletters

The findings of the study come as no shock to those who have campaigned to preserve the NHS publicly funded, says Dr Jacky Davis. Photograph: Alamy

As a complete-time employee of the NHS for a lot more than forty many years I was delighted to go through that the Washington-based mostly Commonwealth Fund, seeking at healthcare across the created world, puts the NHS in pole position total, in spite of astonishingly lower fees matched only by New Zealand (Expert panel costs NHS world’s greatest healthcare system, 18 June). This is a colossal achievement and probably represents the very best and most reasonable assessment of what the NHS is today – despite a lot of pressures and, of course, imperfections, still a exceptional mix of “quality, access and efficiency”. One require hardly add fairness and equity because this blazes out so obviously in comparing our program with, say, the US, where the extremely very best is outstandingly excellent (I worked there for a 12 months), but the peaks are obviously outweighed by the tragic and shameful troughs (I noticed these initial-hand too).

It is usually a pleasure to search soon after visitors from the US unexpectedly requiring emergency healthcare right here (I have knowledgeable this a lot of times in a lengthy job) and hear their comments – nearly usually a mixture of admiration and disbelief that our significantly-maligned healthcare technique can supply this kind of compassion and quality with no unwelcome and exhausting concerns of payment at the point of need to have.

My pride in reading through the report was much more-than-somewhat diminished not just by the unfair and repeated brickbats thrown at us by mainly hostile media coverage, but also, and far far more importantly, the threats posed by continual reorganisation and what numerous see as a gradual unravelling of the founding concepts of the NHS.

It truly is wonderful to see the robust report from Jeremy Hunt, who recognises that the wonderful difficult operate of NHS workers has now been effectively and impartially measured by international specialists, but we need to trumpet this great achievement far more entirely.

Large marks to the Guardian for the front-page story, but why relegate it to the foot of the webpage under the photo of a grieving Brazilian football fan?
Jeffrey Tobias
Professor of cancer medication, UCL, and advisor in clinical oncology, UCL NHS Hospitals Believe in

• Steve Richards hits the nail on the head (If folks come to feel powerless it is because they are, 18 June). Last 12 months I wrote to my regional MP and asked how choices have been produced about the amount and spot of GP practices. I was concerned because the developing of huge new estate had not been supported by a new, nearer, overall health facility. My MP advised me to get in touch with the clinical commissioning unit – even I knew that was incorrect – but I wrote and asked for my request to be passed on. I at some point spoke to an official. She was valuable but there was no way I could have recognized (or located out) that her particular workplace was accountable for GP practices. I invested the latter component of my job as an ombudsman’s investigator. If I could not locate out in which and how to trace this info, what hope, as Steve Richards says, for the patient who just desires to know why they are not able to get an appointment to see their medical doctor?
Maureen Panton
Malvern, Worcs

• The findings of the Commonwealth Fund’s most recent review come as no shock to those who have steadfastly campaigned to maintain our NHS publicly funded, publicly delivered and publicly accountable. The media now requirements to challenge the politicians’ mantra of “we can’t go on like this” and “we cannot afford the NHS”. We require fewer stories focusing on difficulties and far more celebrating the one.5 million patients noticed by the NHS every 36 hours. We need to have to inquire politicians: “If we cannot afford the NHS, now acknowledged as the most value-effective services, what are they suggesting we can afford?”
Dr Jacky Davis
Founder member, Preserve our NHS Public

• So the NHS has been rated the world’s greatest healthcare system? Its only black mark is its bad record on retaining individuals alive. Nothing at all significant then.
Christiane Goaziou
Wotton under Edge, Gloucestershire

Lead to for celebration as NHS is rated the ideal healthcare system | @guardianletters

"My legacy will be a celebration of NHS care"

“Cancer came out of the blue,” explains Kate. “Everything in our lives was going swimmingly. At 29, I was on track to grow to be a consultant” – Kate must be qualifying later this yr – “and Chris and I had just bought a house in Wakefield, in which I was functioning at the stroke unit at Pinderfields Hospital, and we have been talking about when to start a household.” She adds wryly: “Everything seemed best.”

Unbeknownst to Kate, items had been far from perfect inside her. “I started to come to feel a bit poorly. I’d been a bit exhausted, my tummy was tender and I felt sick. But even when I received truly poor soreness in my back, I took some painkillers and carried on.”

At some point, Chris, 36, a supermarket provide chain manager, insisted they went into an emergency department in a Californian hospital, as Kate was plainly turning out to be extremely sick certainly. Right here, her kidneys failed, and after blood tests, medical professionals quickly warned that she had cancer that had spread to her bones. They had been also very clear it was severe and Kate may possibly not recover.

“At very first they imagined it was ovarian cancer, despite the fact that it had currently spread, and tumours have been compressing my ureter tubes, which get urine from the kidneys. A surgeon operated to open the tubes by inserting stents, and that helped stabilise me.”

All through, Kate was “pretty calm, considering”, though Chris went by means of stages of grief and anger. Right after scans, Kate knew she had to get house. Chris sorted the insurance coverage, which paid the US$ 35,000 (£21,000) hospital bill, and the couple were back in Yorkshire by August. “I felt safer I had all my assistance system about me.”

Admitted to St James’s University Hospital in Leeds, Kate underwent much more exams. “It took the pathologists a extended time to function out what sort of cancer I had, but it turned out I didn’t have ovarian cancer alternatively, it was a unusual sort of sarcoma referred to as a desmoplastic small round cell tumour. This is a cancer of the connective tissue that supports internal organs. They determined it had possibly begun in the tissue around my ovaries.”

This sarcoma is so unusual, it is estimated to have an effect on one individual in every single two million, and there is no understanding of its result in or threat variables. “It truly is a single of those factors,” says Kate.

That autumn, Kate’s kidneys failed again as the tumours grew back into the ureter tubes and blocked the stents. She underwent 3 agonizing procedures when tubes had been inserted, via her reduce back, into the kidneys to drain them.

Her oncologist determined to start off chemotherapy, warning her that this kind of cancer was so aggressive that it wouldn’t respond to a little dose. “I had to go the whole hog,” she says.

Every three weeks, Kate invested three to 4 days in hospital on a drip, suffering uncontrollable vomiting. About 10 days later, her bone marrow would fail and she would develop a fever and infection, which meant getting hospitalised once more for strong antibiotics and transfusions.

“Chemo helped with the discomfort in my abdomen, and shrank the tumours,” she says. “But it was clear that the remedy was creating me truly feel far more poorly than the cancer did.”

That New Year’s Eve [2011], Kate lay in a hospital bed viewing the fireworks in excess of the Leeds city skyline, and created a choice to cease the drug regime. “I imagined: ‘I can not do this to myself any longer.’ ”

Amazingly, as the results of the chemo wore off, she felt far better, and inside of 3 weeks was back at perform among her elderly individuals. “I love currently being with individuals,” she says. “When I was a youngster, I constantly knew I wanted to be a medical doctor.”

Her passion meant that even when she returned to function in January 2012 – a patient now, as effectively as a medical doctor – she identified the inevitable fatigue was bearable: “I enjoy my occupation I don’t feel full when I’m not undertaking it.”

That year, Kate settled into a really lengthy – and unexpected – time period of stability lasting about 20 months. “I knew that typical existence expectancy for my cancer was about 14 months from diagnosis. I was undertaking actually properly.” For the duration of that time, she launched her #hellomynameis campaign, and had the joy of seeing so many medics consider up the result in in her name.

Her blog – and two self-published books about her experiences with cancer, The Other Side and The Vibrant Side – had presently caught the focus of fellow medics, as effectively as the public the website has 848 followers and 985 comments to date. With posts about the actuality of end-of-life care, Kate tackles the topic with thoughtful candour and emotional honesty.

Of exceeding her oncologist’s longevity expectations, she wrote: “I fully expected to be pushing up the daisies by now and it genuinely feels like I have hit a brick wall mentally. There is an overpowering feeling of residing on borrowed time.”

Her luck has not held. Last October 2013, Kate located a lump in her neck: scans showed the cancer had quickly progressed. She was warned not to assume a lot longer than 12 weeks – which took her to Christmas. “To be sincere, that appeared this kind of a brief time,” she says. Kate took the “heart-wrenching” decision to return to chemo.

Chris, as ever, has been in continuous support. “He wished me to have it, but it was my determination. He knew how awful it had been before. We’d hid it from the world the make-up went on and the brave face went on. But Chris had watched me suffering near-up.”

The second regime has been produced a little more bearable than just before, as the hospital has produced its procedures, so that Kate (and other patients) can have chemo as an outpatient, and sleep in their own beds at night.

The day I interview Kate is her last planned session for now. The lump in her neck has gone and her tummy feels significantly less tender, she says. But it won’t be until finally later this month, when a scan is due, that Kate will know how significantly extra time her chemo has bought.

Until then, she has #hellomynameis to preserve her occupied. Its influence is spreading – Kate was extremely amused when her own oncologist launched himself to her one particular day. “He explained: ‘Hello my title is…’ – and I laughed. I said: ‘I know who you are.’ ”

She is searching forward to presenting the awards, too, which had been the concept of the chief nursing officer Jane Cummings, and embody, Kate hopes, her values as a clinician. “I want to celebrate excellent care.”

She admits: “It feels remarkable, mind-boggling. I am a regular Yorkshire lass there is absolutely nothing unique about me. Yet these awards have recognised me and my values.”

Also younger, all would agree, to have to think about what she will leave behind, Kate is sanguine about her circumstance. “I would like a legacy that celebrates the care we can supply in the NHS private care that recognises people, not just ailments or individuals.”

For far more, visit drkategranger.wordpress.com and theothersidestory.co.uk. Follow Kate Granger on Twitter (@GrangerKate)

"My legacy will be a celebration of NHS care"