Manchester’s health devolution closer to delegation, says IPPR

12 Aug 16

The move to give Greater Manchester control of health spending is closer to delegation than devolution because of Whitehall’s reluctance to relinquish power, a review by the Institute for Public Policy Research has concluded.

In a report, the think tank warned devolution of health spending, which has seen local control of more than £6bn in health and social care spending, could fail to deliver on its potential, unless Westminster hands over more accountability to local officials.

This comes in the same week the Labour Party selected its metro mayor candidates for Manchester, Liverpool and Birmingham. The IPPR is calling on Andy Burnham, Labour’s Manchester candidate, to make further health devolution a key campaign pledge.

Currently, the health secretary Jeremy Hunt is still ultimately responsible for health and care in Manchester, the think tank highlighted. Giving local mayors clearly defined roles within the NHS would mean they have more ‘skin in the game’, meaning candidates will be more accountable to the electorate for the successful delivery of health and social care.

There is a “very real” risk that health devolution would lead to finger-pointing between central and local government, as the next round of public sector spending cuts bite.

However, it added there was little mileage in the notion that the NHS could ‘lose it’s N’ thanks to devolution. There were already significant regional disparities in care provision despite the existing centralised system, and it was unlikely devolution would make matters worse.

Report author and IPPR researcher Harry Quilter-Pinner said: “Greater Manchester recently received control of its £6bn NHS budget and IPPR’s research suggests that there are significant opportunities presented by these new powers.”

However, he said that the next mayor may not have the powers to address Manchester’s health problems. "Burnham should call for the region to utilise 'devo-health', to undo some of the damage of the 2012 Health and Social Care Act and drive improvements in the social determinants of health. The region should pioneer an alternative vision for the NHS and health policy which delivers for everyone,” he added.

The review found that health devolution has the potential to catalyse NHS reform, especially in the area of health and social care integration. It could also drive improvements in the social determinants of health through the creation of place-based public services.

There is “emerging evidence” that the process has increased the pace and quality of reform in Manchester, the report stated. For example, it has sped up the pooling of budgets between services, and allowed for the creation of Health Innovation Manchester, a new system aligning the NHS, industry and academia in the pursuit of innovation. 

Several other regions – the North East, London and Cornwall – are considering requesting powers on health and care as part of broader devolution packages. However, the IPPR cautioned that the process wasn’t appropriate for every area. Those regions likely to see greater devolution were those most qualified to take on greater powers, especially those local governments with a history of working jointly with the NHS.

Responding to IPPR’s report, mayor of London Sadiq Khan said: “In order to ensure that Londoners have access to the best NHS services real power needs to be devolved from central government to London and other cities.

“This IPPR report makes it clear that people in the capital will benefit from a system which is more flexible and better able to meet the demands and manage the health of their communities.”

 The IPPR is set to engage in an in-depth working programme on the devo-health experiment led by Alan Milburn, former health secretary, and will publish its findings in the coming months.

• It was announced yesterday that Labour’s candidate for the new Liverpool City Region mayoralty will be Steve Rotheram, MP for Liverpool Walton who beat current Liverpool city major Joe Anderson to achieve the selection. In addition, former Labour MP and current member of the European Parliament Siôn Simon has won Labour’s selection for the West Midlands mayor.


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