As a Fellow of the Faculty of Public Health and former NHS Trust Chair, I have released my latest NHS Check report in which I discuss the Devo Manc plans for health and social care are more about devolving financial risk to Greater Manchester and less about devolving decision-making to a local level. It’s about delegation not devolution.
In April 2016, Greater Manchester took responsibility for £6bn of health and social care funding from central Government which was announced as part of the first ‘devolution deal’ in November 2014. There are concerns that £6bn is considerably less than the size of the health and care economy, which is nearer £8bn. At the time, there was also controversy about the secrecy of the deal and the lack of democratic mandate for such a move.
However following the General Election in 2015, the Government pushed forward with Greater Manchester devolution and has rolled its plans for devolution across the country as part of the 2016 Cities and Local Government Act. Although there is cross party support for the principle of devolution and making sure decisions about public services are made with the people they serve, and as close to where they are delivered as possible, there are key risks associated with the arrangements for the devolution of health and care in Greater Manchester.
Fundamentally, the lack of clarity regarding financial and governance arrangements is of grave concern and needs to be addressed as a matter of urgency. The fact that the Chief Executive of health and social care in Greater Manchester will not take up his post until four months after devolved arrangements commenced is a case in point.”
I absolutely support the principles of devolution, but this deal is a sham. It is more about delegation from NHS England. The fact that the Chief Executive won’t take up his post until 22nd July begs the question who’s running the show now? With all but one NHS Trust currently in deficit, the £2bn deficit forecast by 2020 looks somewhat optimistic.
I have outlined action that is urgently needed in my report. There is a need to define the accountability framework more clearly, and within this ensuring both Clinical Commissioning Groups (CCGs) and local authorities on Greater Manchester’s circumference are not marginalised. This should also include the relationship with NHS Trusts and local authority care providers.
A comprehensive, independent assessment of the impacts of the Devo Manc health and social care arrangements, including the distribution of impacts across the Greater Manchester conurbation and populations, should be completed as soon as possible, so that the potential positive effects of an integrated GM health and social system can be enhanced and risks mitigated against. Closer scrutiny of health and social care devolution, and other aspects of Devo Manc, by parliamentary representatives needs to be instigated immediately, for example, by establishing a Grand Committee. The Health Select Committee also has a scrutiny role here and for other areas where health and care is to be devolved/delegated.
I want to see the vision for the greatest and fastest possible improvement in the health and wellbeing of the people of Greater Manchester, and the reduction in health inequalities, being achieved. But we must mitigate against the risks that exist.