Will Osborne’s Manchester 'devolution' fall flat on its face?

Today, Manchester becomes the first English region to “take control of its health spending”, supposedly. But what do patients, NHS campaigners and junior doctors think? 

Barbara Dresner
1 April 2016
P1140129Petitioners in Wilmslow 12 March 2016.jpg

Image: KONP campaigners and junior doctors in George Osborne's Wilmslow constituency

To my relief, last month brought longer days and - even ‘up north’ - often sunny ones. There’s wasn’t much else to cheer me up, as I attended meetings up and down the country to try to figure out what's really going on with Manchester's 'devolution' of its health and social care.

Today, 1 April, Devo Manc is rolled out. But who’s really in charge and what the proposed changes are, are shrouded in secrecy and bizarre – sometimes militaristic - terminology. Of which more in a moment.

I am buoyed every time I join the junior doctors on their picket lines. Buoyed by their determination to fight for a fair deal, and by their devotion to their work. At the latest picket we were joined by some local Labour councillors and a retired former orthopaedic consultant. The hospital had disciplined him for whistleblowing about staff shortages. The courage of such doctors is inspirational.

On March 16 I joined a BMA event in Wilmslow, George Osborne’s constituency. Holding their petition requesting a fair deal for junior doctors and adequate NHS funding, I politely asked passers-by, “Would you sign our petition to support the junior doctors?”

One man, walking with his dog, replied, very firmly: “NO!”

A few strides later he tripped on an uneven patch of paving and fell flat on his face.

Who rushed over to tend to him?

The junior doctors.

Later, as campaigners moved on hear speeches at the Village Hall, one of the doctors said with concern: “The ambulance hasn’t turned up yet for the man who tripped over”. Why, I asked. “They said they’re unusually busy at the moment”. How long had he been waiting?  Over an hour.

Will this account prompt the Chancellor to rethink his funding for the NHS? I doubt it.

Instead, he seems to be pulling off the trick of getting elected councillors to carry the blame for dramatic NHS cuts to come.

On 18 March, as part of the devolution agreement, 37 Greater Manchester organisations committed to produce a comprehensive health and social care plan, aiming for “greater prosperity, better health, and a good quality of life for Greater Manchester people”. Greater Manchester has “some of the poorest health in the country” they noted. A £6bn health and social care budget is expected to enable local services to “better respond to local people's needs, and … tap into their experience and expertise to influence spending plans”.

But the Devo Manc leaders have glossed over the fact that this is a dramatic cut in resources, as Debbie Abrahams pointed out in parliament:

“The devolution offer to Greater Manchester was £6 billion, although the current collective health and social care economy is worth £10 billion.”  

Just how this will play out at local level – such as the ‘Integrated Care Organisation’ being imposed on my area, Tameside – is unclear and worrying.

This month the Parliamentary Health Select Committee visited Salford - another ‘vanguard’, an ‘acute care collaboration site’.  It asked “Will integrating health and social services improve services for patients as well as delivering savings?” There was little evidence on show for this assertion. Questioned on the funding shortfall, Manchester Chief Executive Sir Howard Bernstein admitted the situation was “dynamic” but assured that “we are not going to be far short”.

We are told the focus will be “on preventing ill health and promoting healthy lifestyles”.

I note the focus is not on providing improved, better funded health and social care services, despite the fact that Greater Manchester is short-staffed in both.

The priorities are revealed further in Devo Manc’s strategic plan, which says nothing about comprehensive healthcare, healthcare funded by taxation, or universal healthcare (apart from for children).

But the plan does spell out how the private sector will be involved in new models of care, through the creation of “an overarching Provider Forum which will bring together NHS and non-NHS providers (domiciliary providers, private sector health providers, voluntary and hospices) to be part of the development of new models of care.”

And Devo Manc leaders are also already talking to PWC and private investors to explore a massive injection of more PFI-type contracts to build, repair or maintain hospital  buildings, the Health Services Journal revealed a couple of weeks ago, despite the fact these contracts have been ruinous and simply drain resources from the public to the private sector in the long term.

Many MPs are saying that we can’t undo most of this this market mess (for example, through the NHS Bill, which most failed to strongly support this month) because the NHS can’t face another massive reorganisation.

They should have a look at the changes happening in Manchester, which are likely to foreshadow countrywide changes should the government get its way.

The result: a fragmented, privatised non-national, non-public reduced service redirecting sick people away from expert medical care, aiming to make them pay if they actually receive it.

‘Transformation’ is one of the many jargon buzzwords now used for these ‘new models of care’. I wish Gandalf would appear in his white cloak and transform places like Salford and Tameside into areas where the healthy life expectancy is higher than its current 57 years.

So much for the fantasies.

Manchester’s local plan states explicitly that “services will be delivered through the range of models described in the NHS England Five Year Forward View”. So last month I also went down to ‘Commissioning Live’ in London to hear a bit more about this plan – and how businesses think they can get into our NHS.

There were several surprises. An unexpectedly critical debate on ‘seven day working’, with panel members acknowledging its inadequate funding. A positive reception for John Lister’s talk on privatisation. Several delegates were sympathetic to my KONP badge and views.

But most puzzling of all was the military terminology. We heard how the influence of former US General Stanley McCrystal is utilised to convince areas ‘targeted’ by Simon Stevens to accept the ‘vanguard’ programmes. How Stevens uses mantras including: “Get up people’s noses!” and “Bash it crazy off the wall!”. While a photo of a scene from the Iraq war was shown, the methodology was explained. The speaker went on to outline the tactic of ‘fusion cells’, as used in the war in Afghanistan. I could hardly believe it.

I’m not sure quite how any of this helps NHS patients. It all seems a long way from the spirit of the junior doctors that I met in Wilmslow, rushing to help their antagonist.  

Additional reporting by Caroline Molloy

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