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Is 'DevoManc' the beginning of the end of the NATIONAL Health Service?

Along with new plans from NHS boss Simon Stevens, campaigners discern a worrying trend towards a hotchpotch NHS.

On July 5th 1948 in Manchester Labour Secretary of State for Health Aneurin Bevan announced the birth of the NHS.

On March 27th 2015 in Manchester Conservative Chancellor of the Exchequer George Osborne signed a piece of paper that would bring about the end of a National Health Service. 

In a surprise announcement just weeks before a General Election the Tories signed a deal with the Association of Greater Manchester Authorities, which includes Labour-run Manchester City Council and the 9 other councils in the Greater Manchester area. The actual deal can be read here. It hands over £6bn from central government (or from local NHS structures) to a new organisation to run health and social care services for 2.7 million residents in the Manchester area. On the face of it this may sound attractive - no longer having Whitehall poking its nose into local health issues, but there is much to be concerned about. 

The very fact this deal was hurriedly signed off just before a General Election should ring alarm bells. Many local MPs had not been aware of how advanced the negotiations were and more shockingly the public had not been consulted or asked to make a decision on this huge change to their local NHS. Councillor Jim McMahon, Labour leader of Oldham Council, admitted to the BBC Sunday Politics programme on 1st March 2015 that 'the changes happened too quickly to ask the public what they thought'...

Local GPs, who were promised by the Tories to be more involved in local healthcare with the Health and Social Care Act, were kept in the dark and not given any say in the matter.

The deal appears to have been wrapped up behind closed doors and rushed through prior to an election.

But there are deeper problems.

Local Authorities often outsource services as they cannot provide them from their own resources - this was one reason why Aneurin Bevan didn't offer healthcare provision to Local Authorities in 1948. Bevan ensured a nation service was offered to all across the UK with no regional discrepancies and not at the whim of councillors.

 This deal also significantly advances the risk of charging for services when social care is added into the mix of health care provision. Already in parts of Manchester cuts to services are occurring - as we have seen in Salford this month. With further severe cuts to Local Authorities in the coming years (promised by Tories and Labour) where does this leave health services under this devolved deal?

There are a number of reasons this deal has been done and many of are nakedly political.

Shadow Health Secretary Andy Burnham, whose constituency is in the area, is put on the spot by Osborne, trying to wrong foot him in the election period. The local Labour leadership have not done Andy Burnham any favours!

Osborne is seen as the Northern Hero of the day - riding to the rescue of Manchester. This will help his aspirations to be Tory leader if Cameron fails to win a majority in May 2015

The push for devolution in Manchester helps the 'English votes for English MPs' cause that the Tories are desperate to see come about. Why do they want this - because it will lead to a Tory Government in England for ever - Labour relies on MPs from Scotland and Wales to win majorities in Westminster. The Tories want to stop this. 

Osborne puts his mark on health policy to try and eradicate the disastrous health policies of Andrew Lansley. In one flick of wrist by signing this deal he has sweeps away many of Lansley's 'reforms'- though not their underlying principles, of course.

Local patient groups, local GPs, local NHS staff, local MPs, national medical organisations and patient groups need to be all over this deal like a rash. They need to ask where the consultation was and why democracy has been sidelined. They need to ask what the implications are for their care and what happens when Local Authority budgets are cut further in coming years. 

The Manchester Devolution deal is hugely worrying and has many risks attached to it. There is likely to be much debate on the deal in the coming months but one thing is for sure - the deal is signed, sealed and delivered without so much of a debate or consultation with those it will most likely effect - patients and local NHS staff.

About the author

Dr David Wrigley (@davidgwrigley) is a GP in Carnforth, Lancashire and campaigner on the NHS. He co-wrote the recent book 'NHS for Sale' and contributed to ‘NHS SOS’ – all profits of which go to Keep Our NHS Public.


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