What’s the story Manchester ?
From buses to hospital wards, Greater Manchester is testing whether doing things differently can genuinely make people’s lives better.
Over the last couple of months, I’ve been asked a few times what Manchesterism actually means, and what Greater Manchester might be able to teach other areas looking to reform public services.
It’s a fair question. Recently Manchesterism has become one of those terms that gets used quite a lot, often without much explanation of what it actually means in practice.
And I’m not sure you can talk about Manchesterism without talking about buses.
Bear with me.
It starts with a bus
When Andy Burnham brought Greater Manchester’s buses back under public control, there was plenty of discussion about governance, regulation and who was responsible for what.
But for most people, the questions were much simpler.
Can I get where I need to go? Can I afford it? Does it connect with the rest of my journey? And does it make my life a bit easier?
People weren’t particularly interested in the governance arrangements. They wanted a bus service that worked.
And that’s what I think makes the buses such a useful starting point for understanding Manchesterism.
It’s about taking something fragmented, challenging the way it’s organised and asking a the question, what would this look like if we designed it around the people who actually use it?
From buses to better lives
Greater Manchester is now applying much of that thinking to health, wellbeing and public services through Live Well.
At its heart, Live Well is an attempt to move away from a system that waits for people to reach crisis point before responding, towards one that identifies problems earlier and brings support together around people and communities.
It’s about neighbourhoods, prevention and recognising that the things affecting our lives don’t exist in neat, separate categories.
Because nobody wakes up on Monday with a housing problem, Tuesday with a debt problem and Wednesday with a mental health problem.
Yet we’ve traditionally organised public services as though these issues exist independently of one another. And then we expect people, often at the most difficult point in their lives, to work out how to navigate all of that.
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Live Well is trying to turn that on its head.
The ambition is that wherever someone asks for help, the system takes collective responsibility for connecting them to the support they need.
A genuine ‘no wrong door’ approach.
And importantly, that the complicated business of joining services together happens behind the scenes, rather than becoming another problem for the person seeking help to solve.
So what does that actually look like?
It’s easy to talk about integration, prevention and collaboration. The harder bit is making them work in practice.
At Citizens Advice Manchester, we’re seeing what this can look like through our work with Manchester University NHS Foundation Trust and partners to establish Live Well Hubs across four local hospitals.
The model brings together organisations offering different but complementary types of support.
Citizens Advice Manchester provides advice on money, benefits, debt and housing. The Growth Company supports people with employment and training. Social prescribers from The Big Life Group connect patients with community-based support, while Groundwork’s Green Doctors help people address issues such as cold homes and energy efficiency.
Patients can refer themselves or be referred by a clinician.
But the important part isn’t simply that four organisations are working in the same place. It’s that they’re working together.
Someone might come into hospital because of a health condition, but the things making their life difficult, or preventing them from recovering, might have very little to do with the treatment they’re receiving.
They might be worried about rent arrears. They might be returning to a cold, damp home. They might have lost income because they’ve been unable to work.
Addressing those issues can be fundamental to improving someone’s health and reducing the likelihood of them needing further clinical support.
And rather than expecting the patient to navigate four separate services, the organisations work together to identify what support is needed and how best to provide it.
Since April, the service has supported around 750 people, secured close to £2 million in financial outcomes and helped prevent eight families from becoming homeless.
Those are meaningful outcomes for the people involved. But there’s a bigger question here too. What happens to the wider health and public service system when we start addressing the issues that contribute to poor health, rather than simply responding to their consequences?
That’s what we’re now working to understand through evaluation of the model. We know that problems rarely arrive neatly packaged. Debt can lead to poor mental health. Poor housing can contribute to ill health. Ill health can affect someone’s ability to work, which in turn affects their income.
We also know that intervening earlier can stop some of those problems escalating. The opportunity for Greater Manchester isn’t only to demonstrate that integrated services can work. It’s to build the evidence for how we fund them, how we measure their impact and how we make prevention a sustainable part of the system rather than another short-term initiative.
Back to the buses
The buses remind us that structural reform matters when people feel the difference. The same should be true of public services, help before debt becomes unmanageable, a family staying in its home, a patient leaving hospital with the support they need.
