Health devolution will not work everywhere, says former DoH chief

15 Oct 15

Manchester’s devolution deal might not be easily replicable around the country, a former Department of Health chief has warned.

Speaking at a King’s Fund breakfast event on devolution and health on 13 October, Sir Hugh Taylor, who retired as DoH permanent secretary in 2010, said that, “on the whole”, he was an enthusiast for devolution.

But he cautioned against assumptions that the Manchester model could be easily copied everywhere, as it had benefited from continuity of leadership in the city and its roots were laid down a long time again.

“It’s not a magic bullet … and not easily replicable in other geographies.”

Taylor, who now chairs Guy’s and St Thomas’ NHS Foundation Trust, also observed the difficulty of taking “big decisions” with the agreement of multiple stakeholders.

“My challenge is how is this drive to devolution going to support the big decisions that need to be taken? There is an impetus towards change, but taking big decisions in a group of 31 or 32 is pretty difficult.”

Finally, he warned that devolution could be a distraction from other issues affecting public services, including in health.

“We are still trying to run one of the more efficient health systems in the developed world,” Taylor said.

“Budget caps and then saying ‘over to you’ is not necessarily a shining example of progressiveness. I’m slightly nervous about the prospect that we’ll be trading road improvements for opening GP services as the cash limit bites harder.”

The event also heard from Lord Peter Smith, leader of Wigan Council and chair of the Greater Manchester Combined Authority.

Greater Manchester will assume collective responsibility for its health budget from 1 April 2016. Smith said plans were on track to meet this deadline and described a “spirit of cooperation”.

But he observed that the health service culture was very risk averse and said a systemic change was needed to bring it up to date.

“We’re not going to get structural change in the NHS. That does concern me. We need to do that,” Smith said.

He added: “I [as a local government leader] don’t want to take over health. But if we get this partnership working at the local level we can get it working for people in the 21st century.”

  • Vivienne Russell

    Vivienne Russell is managing editor of Public Finance magazine and

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