Well, it's happened. Not quite in the way we imagined but it has happened. How long has everyone been banging on about 'it's daft to have a gap between health and social care?' Like buying a knife in one shop and going up the road to buy the fork; picking up a shirt in Marks & Sparks and popping next door for a tie.

Some things go together; love and marriage, Starsky and Hutch, a cuppa-builder's and a Hobnob. Health and social care go together. We all know that but no one has figured out how to do it. We are told; there will be no Parliamentary time to pass the laws, no one wants another upheaval, only the NHS can 'do healthcare'... blah, blah.

Forget all that. By the deft use of existing regulations and a delegated authority Greater Manchester is to be given control of their entire �6bn health budget. I'll just pause whilst you read that again...

As part of a move towards devolved government in England, from April 2016 health and social care will be in the hands of a new regional board. Effectively local government will be running everything; dinner ladies, bin men and GPs.  The Greater Manchester Strategic Health and Social Care Partnership Board; more details here.

How has it happened? Through a cunning device; a memorandum of understanding between the Treasury and a new regional board.  Health money will go straight to Manchester. The agreement will include powers over the workforce, regulation, information sharing and NHS buildings.

This side-lines the tariff (they'll set their own) and Monitor is redundant, demotes CCGs to budget administrators (Councillors will decide priorities), by-passes NHS Prop-Co and parks the DH.

If Manchester 'works', expect to see this duplicated in Newcastle, Birmingham, SW peninsular and where ever else they can demonstrate a defined region, a clear health-economy and robust structures to make it all work. How about Boris in London? The speed of this, announced 60-odd days before the election, leaves Labour's policy wonks dancing around their handbags. 

Eight Labour councils, in Andy Burnham's back yard,  talking to a Tory led Government seems to have escaped their 'weaponising' (Comment here).  Surprised by the swiftness? I'm not... I've never underestimated Tarzan's ability to get things done, nor the confidence politicians have in his talent.

There is an urgent need to roll health and social care together, stop wasting time and money on extraneous organisations and to emphasise the National Health Service has also to double as a Neighbourhood Holistic Service.

The pathway into healthcare begins a long way from the GP's front door; housing, jobs, environment, a sure-start for the kids, elder-care, diet, lifestyle, safe roads and education. All of which is out-with the purview of the NHS.

The Health and Social Care Act is dead. LaLa's madness, well on the way to the waste-bin of history. Regional government and vertically integrated care, working on a population based capitated budget, targeting improved outcomes, will bring its own complexity and nay-sayers but it had to happen.

Dangers? Concerns?  Plenty.  Not least the fact that social care is means-tested and health care isn't. How porous the boundary? Dunno. There is little point to boutique CCGs, with their duplicated back-offices and super salaries. Expect redundancies, a return to locality commissioning and service level agreements.

But, remember; health and social care groups arguing about hierarchy and money across town won't necessarily stop arguing across the corridor or across the desk. Health could easily become a local political football.

Local Government is deft at commissioning and outsourcing. If you are squeamish about the private sector... look away now. Councillors live and die by votes in the ballot box and will demand real performance and measurable outcomes... not ticks in the box. LAs have a lot of holes in the road to fill, with tarmac paid for from the plumpcious health budget, 'to reduce traffic accidents'?  No, that's too cynical, even for me!  Oh, and try 'reconfiguring' (closing) services where votes are at stake...

This has Tarzan's finger prints all over it. He has quietly gifted the politicians a solution. A bold, jaw-dropping, 'blimey say that again' solution. A solution that will bring with it complexity to unravel, complications a-plenty and a leap of faith. But, it is probably our last, best chance at joined up care and it will change the nature and shape, colour and texture of the NHS forever. 

A word of warning; the NHS is short of cash, so is Local Government and two turkeys don't make an eagle.  But, now you have it... joined up care; be careful what you wish for. 

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TV doctor and comedian Phil Hammond in conversation with Roy Lilley

59 minutes to save the NHS - can they do it?

 RCN HQ London 1st April - details here.  

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