Cottonopolis to Metropolis

Professor Ben Bridgewater

It is with great optimism that I have started a new role as the Chief Executive of Health Innovation Manchester This is a really exciting new organisation that has recently brought together the considerable assets of the City’s Academic Health Science Centre and the Academic Health Science Network, to fast track health and social care Innovation into the needs of the population of Greater Manchester .

I am not a native of Manchester. I moved up here from London for a Cardiac Surgery Training job in 1993. But my wife is a proper Mancunian, born in St Mary’s Hospital and her father was a GP in Higher Openshaw, running the practice that his father had run before him, so I feel part of it all.

When I arrived in the city I admit that I found it was a place whose riches were not readily apparent. But as I dug, the more I found, and even recently as I have been preparing to take on my new role I have dug deeper and found more and more.

Many will know, but I think it bears repeating, that in the first half of the 19th Century Manchester (or Cottonopolisas it has been called) was regarded as the first modern city. As Sir Robert Peel is alleged to have said “what Manchester does today, the rest of the world does tomorrow”. Manchester’s pre-eminence in the industrial revolution was based on cotton, but it was successful for many reasons other than just its cotton mills. There was an existing textile industry in Manchester and the surrounding Cheshire and Lancashire towns (and maybe all the rain helped the industry), but it was more the commercial centre, based around the warehouses, than the cotton mills per se that drove Manchester’s success. And the surrounding businesses, particularly the development/production of mechanical manufacturing processes and the chemical industries which enhanced cotton production, augmented Manchester to its Global position. All of these industries collaborated to mutual benefit. By 1835 90% of the UK’s cotton industry was focused in and around Manchester. And with these developments people flocked to the city from surrounding towns, the countryside and more widely, especially from Ireland. Unthinkable now, but Manchester’s population increased 5 fold between 1800 and 1850, and by the contemporary standards it was not small to start with. They developed the infrastructure – the canal system was largely in place, roads were enhanced and the first passenger railway in the world was opened between Manchester and Liverpool in 1832. The ship canal came later.

The necessary expansion of the population to serve the industry brought its challenges, and new housing developed, which alongside the mills and the warehouses created the landscape that most associate with the city. It was squalid, cramped and unhealthy – the mortality rate in Manchester was 50% higher than the national average with the infective diseases of TB and Cholera being the big killers. The average life expectancy of a professional person in Manchester in 1840 was 38 years. Political activity was vibrant with the rise of the Trade unions, and Manchester as a city had to start to change itself. They introduced piped water and better sanitation, introducing local developments long before national legislation. And then leisure and culture progressed, with the Halle, the Royal Northern College of Music and the Art gallery. The industrial revolution in Manchester completely changed the world view of how peopled lived and worked and introduced a new type of economy and society.

Post-industrial revolution the city has not stood still – Manchester has spawned great developments such as Turing’s contribution to computer science, and the discovery of Graphene to name but 2. And the city centre redevelopment, including that which happened after the IRA bomb in 1996 (I was a cardiac surgery trainee in the city at the time), has created a modern Manchester Landscape that has changed for the better out of all recognition.

But for me the big draw in coming back ‘home’ to work is the unique deal struck between the local politicians and central government for devolution. As I have traveled around the world for the last couple of years seeing many health care systems in detail, when I explain that the funding for Health and Social Care has been devolved to the city for local decisions,  implementation and accountability the consistent response is: ‘’Wow! Wish we had that here!’’ And it is of course great credit to the city’s politicians for striking the deal, and it only came about because of collaboration within the city, trust and negotiation.

So Greater Manchester has the benefit of a devolved Health and Social Care economy, a strong and vibrant academic life and significant commercial and start-up activity.  Back in 1850 Manchester was one of the world’s pre-eminent cities and it developed challenges related directly to its success which was a result of entrepreneurship, ingenuity, commercialisation, collaboration and political smarts. It required a mixture of these attributes to tackle the challenges it faced back then.

All healthcare systems around the world are facing challenges. Manchester’s are fairly typical but more extreme than most in the UK and related to aging populations, increasing burden of disease, escalating costs of health and social care, variable quality of outcomes and increasing consumer expectations. All systems are struggling to deliver solutions. Whilst Manchester’s challenges are significant, the city is far better placed than most to respond because devolution is the key enabler to doing things very differently. To embed necessary innovation we will need to leverage technology in its many guises and use a digital mind set which will take us to unforeseen levels of collaboration, agility, humility, productivity and entrepreneurship. The parallels with Industrial revolution Manchester are obvious. It is really exciting to be a part of that.

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