Good health is not equally distributed throughout society, a fact that has been well established since the publication of the controversial “Black Report” in the 1980s. There are a number of socio-economic factors—such as housing, skilled employment, and education—that influence health, and subsequently those living in the most deprived communities tend to also be burdened with the worst health outcomes. Fears around overstretched NHS services have led to increasing emphasis being placed on the need for disease prevention and better public health services.
In 2013, amid a number of other structural changes to the NHS, the responsibility for many public health functions moved into the local authority. The idea behind this and the formation of “health and wellbeing boards” was to take a more integrated approach to commissioning local services.
The government decided to take this a step further, and on 1 April this year Greater Manchester became the first region in England to have a merged, locally controlled, health and social care budget. This formed part of the wider devolution of financial control for a number of services from central government to Greater Manchester, known widely as “Devo Manc.” The hope is that aligning health and social care, alongside wider public sector reform, will break down the silos services function within and allow for a more holistic response to the needs of the local population. As a result, decisions regarding health spending will also target the factors that determine ill health.
With this ambitious and challenging transition in mind, it is worth examining the decision that has recently been made by Salford Royal Hospital to close their kitchen and outsource the catering service.
Salford is a metropolitan borough of Greater Manchester and has high levels of deprivation and poor health. Salford Royal is an 839 bed hospital, currently providing freshly prepared meals to patients from an in-house kitchen. At the beginning of February this year, the decision was made that due to refurbishment costs, it would be more financially viable to move to a privatised, ready prepared meal service.
This decision provides a perfect example of what Devo Manc should challenge—where decisions are made based on what will be best for an “organisation,” rather than for the people and the community within which it is situated.
Hospital kitchens can be a great asset to the local community, as demonstrated by examples such as Nottingham University Hospital. They invest £2 million a year in local businesses, with 77% of their expenditure on raw ingredients spent locally. Subsequently, every £1 spent on the catering is said to provide £3 social value in return, largely due to generating new contracts and jobs for local food producers.
If Salford Royal Hospital does close its kitchen, then the proportion of Greater Manchester’s newly devolved £6 billion health and social care budget spent on patient catering will not go back into the local community, but will instead be transferred out of the local area to a privatised company. In addition to this, there will be a loss of skilled jobs as staff move from preparing food to simply heating it up—that is, if they are not entirely moved to another service.
It is clear that Devo Manc is going to face many challenges, including the fact that thanks to austerity measures, local authorities and health services are constantly expected to deliver more with less. Devo Manc has received very mixed responses. Critics see it as more of a “delegation” than “devolution” of control, and concerns have been raised that it is yet another step in the dismantling of the NHS. However, advocates see it as an opportunity to finally develop a more holistic model of healthcare, where care is viewed as part of a wider, integrated approach to service delivery.
We will have to wait and see whether Devo Manc is a success, but what we can hope is that devolution helps to challenge decisions such as the privatisation of the Salford Royal Hospital catering. We cannot expect private companies to be best placed to consider how their service may be used to narrow the health inequalities in a local community.
Elizabeth Atherton is a public health dietician working at Medact on the Sustainable Diets and Health project.
Competing interests: The Sustainable Diets and Health project received funding from the Esmée Fairbairn Foundation.
Note added on 1 October 2016. The author has let us know that some new information has come to light that makes a couple of the sentences factually incorrect. The catering service has not been ‘privatised’ but the hot meal production has been outsourced. The general message of the blog remains the same.