‘Communities provide the best solutions to their own problems’ | Rachel Pugh

Rachel Pugh

A year since Greater Manchester became the first region in England to take control of its £6bn health and social care budget, Jon Rouse is pleased at the progress already made, pointing to figures showing that 62-day cancer waits for Greater Manchester were among the best in the country, referrals to treatment targets are better than the England average and access to mental health services exceeds that of the north and of England as a whole. “I am proud,” he says. “In our first year, we have set up more than 20 programmes – and we are performing better overall in these areas than other parts of the country. It is quite an achievement. The key is to make sure the programmes deliver what we intend.”

As chief officer of the Greater Manchester Health and Social Care Partnership, Rouse is responsible for all the region’s health and social care that previously came under Greater Manchester’s 10 local authorities, 15 NHS trusts and foundation trusts, and 12 clinical commissioning groups. The 37 organisations are pooling their budgets to jointly organise, buy and provide health, care and support services for 2.8 million people across the region.

“Technically what we have in Greater Manchester is delegation,” says Rouse. “But what really matters is what we do. Devolution allows more flexibility on how the budget is allocated.”

Rouse has big ambitions for 2017. He wants to see further reductions in the number of unnecessary hospital admissions, GPs providing quality care to those who really need it through a new focused care programme aimed at the most deprived populations – and he wants to beat national standards on mental health.

But improving the basics are also vital, he says. “Devolution does not, however, mean that poor performance will be tolerated.” Greater Manchester has not met the 95% target for patients to be seen within four hours in A&E over the past 17 months, despite rigorous planning, including reducing hospital occupancies in the run-up to Christmas. The average in England is 85.1%, but Greater Manchester’s worst performing area, Stockport, only reached 70.5% and none of the others even reached the England average, except for Central Manchester (88.9%).

Rouse believes proposals announced this week to reform how urgent care is delivered will change all that. “We need to improve the routine GP service and out-of-hours care, but in return we need the public not to turn up to A&E when they do not need to,” he says. “For that to happen, we need to make it as easy as possible for them to know what the alternatives are. In the past we have not done that.” The plans include an app to inform the public which services are open and how busy they are – and a centralised operational hub in south Manchester, which will coordinate how hospitals respond to demand for urgent care across the region. “We are not downgrading any of our A&Es,” says Rouse. “However, we have designated four of our A&Es as higher acuity hubs.” These, which would treat the sickest patients, are Royal Oldham, Central Manchester, Stockport and Salford Royal.

An acute clinical services strategy is also under way, which aims to standardise and consolidate clinical services. Rouse says all hospitals will continue to provide general services, but would also have specialist roles for particular services. “We want to make sure that each hospital has a distinctive role, playing to its strengths. For example, at present Wigan is renowned for orthopaedics and south Manchester for coronary care,” he says.

Rouse points to the Greater Manchester cancer plan as one of devolution’s top achievements. With the exception of the Christie and Central Manchester University NHS foundation trusts, all the hospitals in Greater Manchester exceeded the 85% standard for patients to receive their first treatment within 62 days.

He admits that delayed discharges from hospital are more problematic, with 312 patients across Greater Manchester clocking up 6,729 days for January 2017 alone. “At the moment we are scrambling and it is not sustainable,” says Rouse. “Every day of every week we are being as creative as possible to find more community capacity.”

With the cumulative social care funding gap in the region predicted to reach £2bn by 2021, what can Rouse do practically to reduce this? He speaks with passion about the region’s new social care plan, launched in February, which aims to provide more support for carers, improve care home standards and encourage more people into social care through a new apprentice scheme. At least 70,000 people across the region are carers for more than 50 hours a week. If even 5% withdrew their support, it would leave an additional 3,500 people suddenly in need of the provision of full-time care from the state.

But in the end it is down to money, he says. “Integration is not the panacea. We need a new settlement in return for the way that social care is administered.” Whether Greater Manchester’s share of the £2bn extra funding announced this month is enough remains to be seen.

What about those who say “Devo Manc” is undemocratic and centralising? Rouse agrees that there was no referendum to introduce it, but he insists that there are benefits: “When something goes wrong in one part of the system, it is owned collectively. We treat it as one NHS and social care.

“Our strongest assets are our communities,” he continues. “Communities have the strength and provide the best solutions to their own problems. You have to facilitate that. I want an end to paternalism and talking shops, and to see the release of the power of the community.” It all sounds a bit Pollyannaish. What does he worry about? “There is the danger that the plans and discussions become disconnected and do not translate into changes at ground level,” Rouse admits. “My measure of success will be what people’s experience of healthcare is and whether it has improved. Devolution is not magic dust.”

Additional reporting by Anna Bawden and Pamela Duncan

CV

Age: 48.

Lives: Altrincham.

Family: Married, two daughters.

Education: Latimer Comprehensive school, Kettering; University of Manchester: law degree; London Metropolitan University: MA urban policy; University of Nottingham: MBA.

Career: 2016 to present: chief officer, Greater Manchester Health and Social Care Partnership; 2013-2016: director general, social care, local government and care partnerships, Department of Health; 2007-2013: chief executive, London Borough of Croydon; 2004-2007: chief executive, the Housing Corporation; 2000-2004: chief executive, Commission for Architecture and the Built Environment; 1998–99: secretary, the government’s Urban Task Force; 1995–98: policy and communications manager, English Partnerships; 1994–95: private secretary to housing minister; 1993–94: policy analyst, Energy Saving Trust;

1992–93: principal policy officer, Ealing borough council.

Interests: Playing clarinet, watching Queens Park Rangers FC away and Altrincham FC at home, family life and planning great holidays.

‘Communities provide the best solutions to their own problems’ | Rachel Pugh

London’s black communities disproportionately exposed to air pollution – study

Black communities in London are disproportionately more likely to breathe illegal levels of air pollution than white and Asian ones, new research seen exclusively by the Guardian shows.

The study for the mayor of London shows black, African and Caribbean people account for 15.3% of all Londoners exposed to nitrogen dioxide (NO2) levels that breach EU limits, but they account for just 13.3% of the city’s population.

The proportion of white and Asian individuals exposed to the dangerous NO2 levels is lower than the fraction of the population they account for, said Aether, the consultancy which produced the report.

Southwark, Lambeth and Hackney were among the boroughs with an overlap of both a higher proportion of black residents and

other’ ethnic groups are more likely to be exposed to above EU NO2 limit value concentrations than those in areas with a high proportion of white people,” said the Aether study. “This effect is not seen for areas with a high proportion of Asian groups.”

pollution graphic

But because of the “very mixed ethnic geography of London”, the pattern is less strong between ethnicity and exposure than the one between deprivation and exposure, Aether found. In areas with poor air quality, 32% of people living there were from the most deprived groups, versus 7% from the least deprived.

“This research shows the disproportionate impact air pollution has on deprived communities in London,” said Aether’s director, Katie King.

“We have known for some time now that poor families end up living in cheaper housing which is often in close proximity to busy roads,” said a spokesman for the air quality unit at King’s College London.

However, he said the new study’s use of proportionate data was misleading, as in absolute terms there are more Asian and white people exposed to high NO2 levels.

Last month, the Black Lives Matter UK group linked ethnicity and environmental issues during a protest at London City airport – although the protestors were also criticised for their largely white membership.

The study compiled King’s data on NO2 concentrations in 2013 – the most recent available – census results, official statistics on deprivation and ethnic profiles of small areas in London. In total, 1.9 million people in London were exposed to NO2 concentrations above the EU’s annual average limit.

The work is an update of a report which the former mayor Boris Johnson was accused of burying when Khan took office. That earlier report showed 433 primary schools were exposed to NO2 above the limits in 2010, with that number falling to 360 by 2013 in today’s study, showing some areas have got cleaner.

Transport for London (TfL) published a consultation on Monday seeking Londoners’ views on Khan’s new measures to tackle the problem. They include whether to introduce a £10 emissions surcharge in October 2017, the so-called T-charge, which will mostly apply to pre-2005 diesel cars.

Khan and TfL are also consulting on whether to bring in an enlarged “ultra low emissions zone” (Ulez) in 2019 rather than 2020 as previously planned, charging owners of dirtier cars £12.50 to enter. Both charges will be in addition to the existing £11.50 congestion charge.

“Toxic air in London is a health emergency that requires bold action, including introducing charges for older polluting vehicles and expanding the Ulez,” said Khan.

Environmental groups and thinktanks welcomed the proposals, but Friends of the Earth said the mayor needed to go further.

“To bring down London’s air pollution as quickly as possible, Sadiq Khan must extend the Ulez for all vehicles across the whole of London; and create a plan for phasing out diesel on London’s roads altogether,” said Sophie Neuburg, a campaigner at the green group.

Next week the government faces a court case brought by environmental law firm ClientEarth over what it says is an inadequate plan to reduce NO2 pollution.

“Today’s announcement sends a clear message to the government that it needs to get a grip with this public health crisis. This is a national problem that needs a national solution. That is why we are taking them back to court next week,” said Alan Andrews, a ClientEarth lawyer.

London’s black communities disproportionately exposed to air pollution – study

The NHS secret is out. And local communities won"t like it

When Simon Stevens became NHS England’s chief executive in April 2014 he disavowed his predecessor David Nicholson’s radical centralisation of specialist hospital treatment into far fewer places.

Stevens also went further, using his first interview in the post to pledge to maintain local hospitals. Every NHS leader, and every MP, knows how attached the great British public is to the bricks and mortar of their local NHS. The last thing Stevens wanted was to face opposition by campaign groups, councillors and MPs to a particular A&E or maternity unit being downgraded or closed, and certainly not a wave of such protests in many parts of England simultaneously battling to save much-loved local services.

Yet that is the growing risk he now faces as a result of the 44 regional sustainability and transformation plans (STPs). The disclosure of controversial changes planned in north-west London, Leicestershire and the West Midlands – including entire hospitals being downgraded or closed – could easily result in England-wide protests.

NHS bosses say the plans are necessary for the sake of better care, modernisation and financial balance but an angry, disbelieving public is expected to fight tooth and nail against the loss of the local services.

The standoff over STPs has been coming for months and prefaces major political battles ahead which will involve unprecedented examination of the government’s record on and plans for the NHS. Are STPs part of an undeclared Tory plot to prepare the NHS for much greater privatisation after 2020? Or are they designed to move the health service from an illness treatment service to one that prevents ill-health in the first place?

Until now, STPs have been shrouded in secrecy. NHS England, which is driving the process, advised the boards of acute hospital trusts to discuss the plans in the private session of their monthly meetings. Labour MP Justin Madders, a shadow health minister, recently outlined his concern about the lack of public attention so far on “Jeremy Hunt’s opaque and secretive reorganisation of the NHS, which is being drawn up behind closed doors at this very moment through sustainability and transformation plans”. That deliberate hiding from public view of plans for significant changes to how and where patients are cared for is now over, earlier than NHS England planned. The public debate about what NHS services need to look like in order for the country’s most cherished institution to survive is now under way, and not before time.

Official NHS documents, albeit laden with the service’s usual array of buzz phrases, set out the purpose of STPs. NHS England calls them “blueprints [which] will be place-based, multi-year plans built around the needs of local populations”. It continues: “STPs are geographic areas in which people and organisations work together to develop robust plans to transform the way that health and care is planned and delivered for their populations.”

The overall rationale is simple: transform how care is organised and provided in order to keep the NHS sustainable as a system of healthcare. But it will be hugely difficult to convince a sceptical public to back such far-reaching changes.

Whether Jeremy Hunt or Theresa May likes it or not, the belated disclosure of the STPs will lead to fierce scrutiny of the government’s performance on and plans for the health service. Are the proposals helping to prepare the service for much greater privatisation after 2020? Have they only come about because the government has for years been giving the NHS much less money than it needs to deal with the rapid, relentless rise in demand it is facing as a result of the ageing population and the emerging disaster of lifestyle-related illness? Or are they a sincere attempt to make a stay in hospital the last resort because people are much better looked after in or near their homes by GPs, nurses, therapists and specialists?

For NHS chiefs such as Stevens, rapid progress on STPs is an urgent priority. They see the changes that STPs will usher in as the best way to achieve three key aims: to improve people’s health; to tackle the fact that there is still far too much variation in the quality of care many patients receive; and to address the £30bn gap in NHS funding which is projected to have emerged by 2020-21. Ministers have pledged to provide £8bn of the £30bn. But Stevens and Jim Mackey, head of the service’s financial regulator, NHS Improvement, have to find the other £22bn. Almost no one in the NHS thinks it can be done, but STPs are their way of trying. They have to satisfy the Department of Health, and it has to persuade the Treasury, that the NHS can sort out a financial mess that, incidentally, it did not create.

Reconfiguration of hospital services – NHS-speak for shutting things such as A&E and maternity units – is a key part of their plans. NHS Improvement last month told the leaders of the 44 STP footprints to plan for “the consolidation of unsustainable services”. The growing fear among NHS campaigners is that the definition of “unsustainable” has already been agreed behind closed doors, and that it will lead to a huge reorganisation of NHS services.

The whole STP process is fraught with risk and uncertainty. As Hugh Alderwick of the King’s Fund points out, closing bits or all of hospitals does not necessarily save money or improve care. There is also the fact that, as the Nuffield Trust health thinktank’s chief executive, Nigel Edwards, points out, care still has to be provided somewhere and that still costs money.

Crucially, for services to be delivered outside rather than inside hospitals there has to be enough capacity in GP and other community-based forms of care. There isn’t, especially with family doctors already struggling to meet demand. They have no spare capacity. There are also, as some of the STP plans admit, too few staff across the NHS to make this bright new dawn a reality. All these practical considerations may prove even more significant obstacles to the implementation of this covert reorganisation of the NHS than public and political concern.

The NHS secret is out. And local communities won"t like it

Alzheimer"s Society champions Dementia Pleasant Communities

Sponsored by Lloyds Banking Group and supported by the Telegraph – the panel of judges included Telegraph editor Chris Evans, and Jeremy Hughes, chief executive of the Alzheimer’s Society – the awards recognise communities, organisations and folks who have aided to make their neighbourhood or workplace more dementia-pleasant.

The Sporting Memories Network, which supports local community-primarily based projects that tap into people’s passion for sport, was also singled out for an award.

A full list of winners will be offered from 21 Could at alzheimers.org.uk/dementiafriendlyawards

Alzheimer"s Society champions Dementia Pleasant Communities

More study on FGM essential amid migrant communities | @guardianletters

As a single of the people concerned in the estimates of women in England and Wales impacted by female genital mutilation and the numbers of girls at chance which are currently being utilised in the current campaign, I agree with Nadifa Mohamed (Comment, 10 March) that these are now out of date. They have been based mostly on the 2001 census and surveys accomplished in FGM-practising countries in the late 1990s and the early 2000s. This is why we have been commissioned to make new estimates, primarily based on information from the 2011 census and much more recent surveys. This operate is now underneath way, with the aim of delivering data to make appropriate maternity and gynaecology care offered to impacted girls and little one protection providers, exactly where needed, for their daughters.

Taken as a total, the surveys demonstrate that in some countries, this kind of as Kenya, the practice has declined, while in other people it has not and that in nations in which it is most prevalent, reduced proportions of ladies and girls feel it need to end. They also show wide distinctions amongst geographical locations and social groupings inside of nations, with a lot more-educated girls becoming a lot much less likely to have been impacted. These differences are likely to influence the extent to which the practice is abandoned when girls migrate and underline the want to avoid stereotyping people. For instance, Nadifa Mohamed’s Somali family and other Somali households she knows have abandoned the practice, whilst neighborhood groups tell us that other individuals have not accomplished so.

We have no reputable data for England and Wales. There is no code for FGM in the international classification of ailments, so it is not recorded in national information assortment systems, despite the fact that the Department of Overall health is now making an attempt to alter this. It is reasonable, though not excellent, to use information from migrant women’s nations of origin to estimate the prevalence of FGM amongst them, but applying these assumptions to their daughters is problematic. This signifies that, as in our earlier report, any estimates we make will have to be quite tentative. We hope they will prompt in-depth analysis which will involve migrant communities immediately and inform the eradication of FGM in this country.
Alison Macfarlane
City University London

• The one action which would curtail this barbaric practice is compulsory examination of kids. The public’s growing horror above FGM would definitely overtake considerations about civil liberties. In France, the place examination is mandatory, there have been in excess of 100 productive prosecutions. In this nation, nil, but FGM has been unlawful here given that 1985.
Michael Berkeley
Property of Lords

More study on FGM essential amid migrant communities | @guardianletters

Tim Flannery says coal communities are becoming kept in dark about dangers

Climate scientist Tim Flannery says communities living close to coalmines are currently being kept in the dark about the dangers, and has called for the inquiry into the results of wind turbines on wellness to also seem at mines and fires.

Thousands of residents have been affected by the fire at the Hazelwood coalmine which has been burning for 3 weeks, sending smoke across the neighborhood of Morwell in Victoria.

Flannery, the former chief commissioner of the Climate Commission and now head of the Climate Council, has expressed concern for the wellness of men and women exposed to the smoke, and questioned regardless of whether ample preparation was accomplished by mine operator GDF Suez.

The Abbott government has promised to commission “comprehensive” investigation into the attainable wellness dangers of wind turbines.

“Coal fires are a notorious risk for coalmines. In North America total towns have had to be relocated because of fires that have been uncontrollable,” Flannery stated.

“In the US and Canada there are something like fifty five,000 deaths associated to burning coal,” he stated, citing a statement from the US organisation Doctors for Social Obligation.

Medical professionals earlier this week warned of the danger to residents of Morwell from carcinogenic particulate pollution, which was discovered to be at amounts up to 20 occasions the standard average.

Vulnerable groups of folks in South Morwell have been recommended to temporarily relocate due to the danger of PM2.5 particle, but numerous residents expressed confusion about the dangers.

Flannery called for a government inquiry into all Australian mines and the risks to communities.

“Our government is doing an inquiry into the overall health affect of wind [turbines], but here we’ve acquired this chance with coal. If the federal government expanded their inquiry that would be excellent commence,” he explained.

“I’m anxious that we do not but know what this coal fire means for the wellness of firefighters and the individuals of Morwell,” Flannery told representatives of the Australian Nursing and Midwifery Federation.

Flannery questioned whether GDF Suez was taking ample action to maintain the local community informed and mentioned the fire highlighted the require for better preparation and inquiry into the state of mines all around the country, and the risks they posed to nearby communities.

“Do the businesses operating these operations know the health risks? If they do, then they need to share them. If not, then why not?” Flannery said in a statement.

“Other crucial queries have not been answered. Why did the fire take hold? Did GDF Suez correctly clean up the mine website?

“The core of our concern is that this is a widespread chance that is unacknowledged in the community, but without information on other coalmines we’re just in the dark.”

GDF Suez said in a statement on 20 January that the fire, which started in a element of the mine not utilized for thirty many years, is “one of the most significant fire circumstances ever confronted at the Morwell mine”, and rejected accusations that leftover infrastructure was not removed from the internet site.

On Wednesday the firm also said rehabilitation perform was carried out in 2007-08 in “a area of the northern batters … undertaken by truck and shovel, exactly where some of the exposed coal faces in this region had been covered with clay”.

GDF Suez mentioned all around 85% of the fire was now contained.

GDF Suez and the prime minister’s workplace have been contacted for further comment.

Tim Flannery says coal communities are becoming kept in dark about dangers