Once successive governments had enshrined “devolution” (smaller mutual) it was only logical that the Regional Health Service covering your post code be broken up into smaller units. In many ways this can be seen as positive, but it is also risky. The people of Manchester may well find that the “rules of the game” will not allow the overt rationing decisions that are needed to be taken. All the health services are going bust, so yet another “risk” does not upset the treasury any longer.. What is the safety net/? What is the worse case scenario? Who will pick up the tab?
Ten Manchester councils are to be given control over £6 billion of NHS spending in a significant step to devolve powers from Whitehall to city regions.
The move is part of the chancellor’s plan to create a “northern powerhouse” to rival London’s economy in response to the Scottish referendum.
Doctors and nurses warned that the scheme must not become a way for councils to raid the NHS budget.
Key details have yet to be thrashed out, with council leaders claiming that they would get statutory powers over the NHS budget and health bosses insisting that it would be a voluntary arrangement.
In November George Osborne devolved £2 billion to the ten local authorities and promised greater powers over transport, housing and skills. The deal, seen as a political move to woo voters and wrongfoot Labour, was linked to a directly elected mayor, to be in post by 2017.
The councils, predominantly made up of Labour councillors, have since pressed Mr Osborne and the health department for greater powers over NHS spending so that they can better integrate health and social care. However, Labour nationally was cooler on the plans.
Andy Burnham, the shadow health secretary, said: “My worry is having a ‘Swiss cheese’ effect in the NHS, whereby cities are opting out.”
Simon Stevens, chief executive of NHS England, said: “We want to back local leaders and communities who come together to improve healthcare of their residents and patients. While this new model won’t necessarily be right for many other parts of England, for Greater Manchester the time is right.”
Tony Travers, a local government expert at the London School of Economics, said that if the entire health budget for Manchester were devolved it would be “the most radical change in health care since the NHS was created.” He added: “There will be a queue of every city region in the country, including London, wanting to get in on this.”
Boris Johnson indicated that he could be one of the first in the queue. A spokesman for the mayor of London said: “Devolving powers is vital to the future of cities.”
Mark Porter, chairman of the British Medical Association’s council, said: “There is no doubt that patients would benefit from more joined-up health and social care. However, any plans to do so would have to be underpinned by clear funding to ensure that an already dangerously over-stretched NHS budget isn’t used to prop up a woefully underfunded social care budget.”
More details of the Manchester scheme are expected tomorrow.
Update 28th March 2015.
Labour List comments: Devolving NHS budget to Greater Manchester will create a “two-tier health service”, says Burnham Since writing the original posting it occurs that there is another disadvantage. If multiple cities are devolved, then the former system of varying monies from the richer cities to the poorer rural areas will be impossible as there will be fewer and fewer providers.