Is devolution a good deal for Manchester's NHS?

(Originally published by the Guardian)

An NHS hospital. Photo by Wikimedia Commons
We’re told the NHS is at breaking point. A recent report from Quality Watch claims the UK is falling behind many other high-income countries on healthcare, David Cameron is pushing for a seven-day health service and, earlier this week, health secretary Jeremy Hunt caused controversy by calling for NHS consultants to start working weekends.

When the government announced in February that Greater Manchester would become the first English region to be handed full control of its £6bn health budget from April 2016, the news was presented by Westminster as a triumph for democracy. Chancellor George Osborne called the move an “exciting development” that would "give people in Manchester control over their own affairs."

But not everyone agrees, with critics arguing that devolution could prove chaotic and lamenting that the public were never consulted about the plans. On Thursday four expert panelists joined Guardian members at Manchester Central Library to debate the future of the region’s healthcare. So, is devolution good for our health? Here’s what they thought:


Gross health inequality: Claire Reynolds, a Tameside Councillor, kicked off the debate by arguing that the economic disparity between London and Manchester had created a health gap which could only be redressed by bringing the NHS under local control. “Being born in Greater Manchester still means being more likely to experience significant health inequalities and live a shorter life,” said Reynolds. Steve Connor from the Oglesby Charitable Foundation agreed, citing a report he recently co-authored titled Tackling Inequalities in Health across Greater Manchester which claims there is a 17-year life expectancy gap between Manchester and London.

Giving control back to people: Connor insisted that devolving NHS powers from Whitehall to Manchester could only be a good thing for democracy. “Imagine how bonkers it would be if we said to Whitehall we didn’t want any control over our own future …If you want to know who’s pulling levers I’d rather they were sat in Manchester than Whitehall so I could find them and knock some sense into them,” he said, to cheers from the audience.

Centralised approach doesn’t work: Reynolds, who has previously worked in 10 Downing Street, argued that centralised decision-making over public services is an inefficient and “fundamentally flawed” approach. “I’ve witnessed senior number 10 advisers lengthily debating the pros and cons between building a new hospital in Merseyside and Tameside before a junior minister pointed out the Tameside option had been built previously,” she said. “It is because of farcical experiences like this that I cheered when devolution to Greater Manchester was rushed through this spring.”

Social revolution: Chief Executive of NHS England, Simon Stevens has spoken of the need for the NHS to become a “social movement” powered by ordinary people at a local level, a sentiment echoed by the panellists in favour of the motion. Connors was keen to echo the sentiment: “In 2015 it’s completely unacceptable in a city like ours to see a young girl facing 17 years less of life,” he said, “so we do need a social movement, a cultural shift. As my friend Tony Wilson once said, ‘This is Manchester and we do things differently here.’”


Private sector influence: Under the terms of devolution healthcare and social care will be merged under one banner. Dr Kailash Chand of the British Medical Association (BMA) warned this could lead to greater private sector control over the NHS. “The BMA is keen to understand whether the proportion of NHS services being delivered by the private sector is likely to increase. The social care sector is now dominated by private providers and the ability of the NHS to act as a coordinated service continues to be reduced because competition is encouraged between organisations.”

No democracy: David Fernandez-Arias, a supporter of the Referendum Campaign for Democratic Devolution argued there was nothing democratic about plans to devolve NHS powers to Manchester. “These new deals have been done with no public awareness, no public consultation, no democratic engagement, no scrutiny and no impact assessment,” he said, adding that the plans amounted to a “treasury led fiscal decentralisation” rather than a democratic devolution of powers.

Backdrop of austerity: Fernandez-Arias reminded the audience that local NHS budgets would still be determined centrally amid the backdrop of national austerity. In a deal which he compared to the Eurozone bailout programme, Arias explained that local authorities will be required to “unlock” funding by demonstrating to the treasury that its investments have met their objectives and contributed to national growth. One retired NHS worker in the audience expressed his scepticism that the plans would help improve the lives of ordinary Mancunions: “What we haven’t heard is how Devo Manc will help to achieve any benefits and facilitate reducing health inequalities,” he said.

Flawed NHS model: Dr Chand told the audience that while he is in favour of the principle of devolution, the plans failed to address major flaws in the NHS model. The NHS, he pointed out, continues to prioritise diagnosis and treatment over prevention strategies with only 2.5% of its budget spent on public health. “We do need devolution but this model will totally forget the real fundamental challenges that the NHS faces,” he said, “The real problem is about the prevention of health, the lifestyle diseases, the diet related diseases – there’s nothing [in these plans] as far as that is concerned.”