‘Devo-Manc’: Madness or Modernity?
Last week the Manchester Evening News broke the news that the Greater Manchester Combined Authority would receive control of the £6bn NHS healthcare budget spent annually in the area.
For Chancellor George Osborne, one of the main architects behind the plan, this was another piece in his “northern powerhouse” jigsaw.
Catching almost everyone by surprise, the deal will see the 10 councils, 12 clinical commissioning groups, 15 NHS providers and NHS England come together to control the joint budget and deliver services across the region. For the 10 councils who have worked together since the mid-1980s, this will be by far their biggest challenge to date.
Unusually for such a major reorganisation and devolution of power, the transfer of health finance and responsibility occurred without a referendum. Many will be surprised a region that only two years ago voted ‘No’ to having an elected mayor, will now have control of more than a quarter of all Government money spent in the area. That’s because the announcement on the health budget follows a similar transfer of powers in November that gave Manchester control over transport, the welfare-to-work scheme, business support schemes, and housing schemes. To oversee all this new responsibility will be a directly elected Mayor, one who is more powerful than the London Mayor, and one who 53% of voters opposed in an election where 75% of the electorate failed to vote.
The combining of health and social care budgets in Manchester is a major step forward for the integration agenda many believe will help save money, improve patient outcomes, and ultimately revive a health and social care system on its knees.
The new plan provides immense potential to improve the quality of services, patient experience, and health outcomes for the people of Manchester. Many blamed social care cuts for this winter’s hospitals crisis, with older people who have no clinical needs stuck trapped in acute wards because of delayed discharges and transfers. On its own, an effective ‘step-down’ service could save millions of pounds. Where separate budgets have prevented progress before, the new Manchester-wide health service has the opportunity to deliver the types of innovative new programmes many have long dreamed of.
But the proposals aren’t without risk. Manchester will take control of health spending in April 2016, a full year before the Greater Manchester mayor is elected to oversee it. Many have warned that this is frighteningly fast devolution of power and responsibility, with a timeline of just 14 months to put the necessary structures and oversight in place before launch day.
Labour, whose heartland will host this experiment, have warned of a ‘Swiss-cheese NHS’. Shadow Health Secretary, Andy Burnham – the MP for Leigh, part of the Greater Manchester area – criticised the plans as a further break-up of the National Health Service, “where some bits of the system are operating to different rules or have different powers or freedoms.”
Burnham has long called for integrated health and social care budgets; indeed it is one of the central parts of Labour plans for the health service if elected this May. Yet he would strongly prefer integration on a national scale, and the announcement last week not only stole his thunder on the integration agenda, with the Tories claiming they are delivering necessary reform, but will be yet another NHS reform Labour will seek to reverse if elected.
But it is not just the Opposition parties who have expressed concerns about the plans. Dr Kailash Chand, Deputy Chair of the British Medical Association and a GP in Tameside, warned this was, “reform on a breathtaking scale”, and highlighted that, “the plan involves no new money, does not restore the £3bn cuts in social care, does not deal with the eligibility contradictions between free NHS services and means-tested and restricted social care.”
It should also not be forgotten that Greater Manchester hospitals are currently running a £40million deficit, and there is no clarity on who will continue to fund this under the new deal, nor who will bail the system out if the whole project gets into financial and care quality difficulties.
Finally, where Manchester leads, others will surely want to follow. London, which has long had both a directly elected Mayor and Greater London Assembly, will surely want a similar deal for the capital. Indeed Labour Mayoral candidate Tessa Jowell was swift to call for it. Against this backdrop, Burnham’s warning of a disjointed NHS system may well become a reality. Whilst local control and responsibility may allow local politicians to solve local issues, it also creates a national headache in terms of eligibility criteria. Is it so farfetched to believe some treatments would be funded in Manchester which are not funded elsewhere? In social care the UK has long had a disjointed eligibility criteria, with different local authorities judging the care needs of the same individual differently. Someone eligible for full support in Cornwall may have only received a 15 minute home care visit in Birmingham. The recent Care Act finally resolved this postcode lottery – the Manchester devolution project risks bringing it straight back again on a larger scale.
However, regardless of the risks, this is a once in a lifetime opportunity for Greater Manchester to demonstrate how effective joined up commissioning and strong local decision making can tackle a health and social care crisis that is rapidly getting beyond repair. The health and social care system needs radical reform in order to continue to provide the level of service we all demand, remain free at the point of use, and ensure the needs of an aging population are met. Against this backdrop, a bold, innovative and risky initiative may be just the medicine an ailing an NHS needs. Like the 1970’s TV show, the Six Million Dollar Man, the Government and civic leaders in Manchester will hope this experiment provides the “Better. Faster. Stronger” health and social care system the UK so desperately needs.