This week it was announced that Greater Manchester is to become the first English region to gain full control of its health and social care spending, some £6 billion in total. The decision is the latest in a wider move towards regional devolution: devo-Manc for want of a better term.
Under plans unveiled by George Osborne, the city’s civic leaders and, ultimately, its directly elected mayor will have control over how budgets are allocated, enabling them to integrate health and social care services and, hopefully, ease pressures on front line clinical services.
The Chancellor referred to this change as a “really exciting development” and as “giving people in Manchester greater control over their own affairs…which is central to our vision of the ‘northern powerhouse.’”
Labour’s response to the move has been one of resigned acceptance. Though Shadow Health Minister Andy Burnham suggested he was “a bit worried” that the plans could “point to further break-up of the idea of the National Health Service” criticism has been muted, suggesting tacit agreement. Indeed, Manchester’s Labour led council has been keen to back the plans and privately a number of backbenchers have openly complained that the Chancellor has effectively usurped their own designs for devolution within England. Even The New Statesman, certainly no admirer of Mr. Osborne, called the developments “a great leap forward.”
In truth, the NHS has not been truly national since 1999, when services in Wales, Scotland and Northern Ireland were devolved to the new Assemblies. However, the move towards health provision on a regional level in England seems to necessitate a re-evaluation of how the health service functions and how it will develop in the future.
Proponents of the move hope that decision making at a local level will add the kind of flexibility needed to adapt to the challenges of a rapidly ageing society. Long-term conditions like diabetes, dementia and depression are now responsible for over seventy percent of the state’s health care spending, yet all require both clinical and non-clinical care.
Given the financial strains of a disproportionately older popular, there is growing acceptance that the budgets for care services – which generally sit with local authorities – and medical treatment – which sit with Clinical Commissioning Groups – should be merged and administered at a local level. Dr Hamish Stedman, chair of Salford Clinical Commissioning Group, for example, suggests that “this is genuine opportunity to enhance health outcomes for the people of Greater Manchester by aligning health and social care and public sector reform. Treating a person as a whole - rather than by separate conditions - is designed to bring long-term benefits and independence.”
However, the term “quasi-feudal” has already been used by critics for whom regionalisation will entrench the division between good and poor quality services. Healthcare expenditure and service provision as influence by a range of different factors not least social deprivation and access to services. Currently there is little indication as to how devolution in health care will take this into account or how resources will be effectively distributed, raising fears of a ‘postcode lottery’ for services.
There has also been little public discussion as to whether national targets will be scrapped in favour of local goals, possibly placing Clinical Commissioning Groups in a particularly nervous position and raising fresh questions as to the appropriateness of the 2012 Health and Social Care Bill.
Nigel Lawson once referred to the National Health Service as “the closest thing the English have to a religion” and it remains a key electoral issue for voters of all hues. With regional devolution, a new chapter in the NHS’ history is being written, but the long-term implication of this policy require closer scrutiny. Whole person care is undoubtedly a step in the right direction, but safeguards must be made to guarantee that regional disparities are considered and targets set appropriately. Similarly, any further changes should consider the upheaval that has already taken place and, where possible, provide measures to protect, for example, Clinical Commissioning Groups and front line staff who will, unfortunately, pay the price for any future failures.
The NHS has long been a proverbial political football, a situation that benefits neither staff nor, ultimately, patients. Care is needed to ensure that devolution doesn't continue this long, and ultimately ineffective, approach to policy.