The devolution of health and social care budget in Greater Manchester represents a bold, radical, and courageous approach for the NHS; albeit this increased localism is not unusual in an international context. At an event held recently in Manchester it was good to see the optimism and enthusiasm from many in the room both at the opportunity to try something different and at the possibilities offered. However, there is no escaping the bottom line, which is that significant savings estimated at between 13% and 17% need to be found against a backdrop of several years of static budgets and efficiency savings. This, combined with the risk of double running costs (for which there is no additional funding) as new models of care are introduced and the risk of additional need being uncovered as part of service redesign pose a huge financial risk to the proposal. The overwhelming likelihood is that, in response to this, thresholds for services and the types of care offered are likely to be raised, which could bring conflict with the NHS Constitution that gives patients rights around access, timeliness and choice of provider. It also risks losing public support so patient involvement and consultation throughout the formulation and delivery of the project will be key.
Geographically too there is a danger that the process is overly-focused on Manchester, when it is in fact a regional re-organisation, and there is a risk that those living on the periphery of the area will choose to register across the boundary if they perceive the service there to be preferential as has been seen on the England/Wales border. This geographic inequality could be worsened because the easiest way to generate savings will be to close acute beds, and the risk is that this will be targeted at the less densely populated areas and less specialist Trusts.
The CLAHRC West Midlands will be watching closely; both the process of devolution and the evaluation of it. There seems to be considerable political traction associated with the DevoManc and there is a strong possibility that other regions – willingly or unwillingly – may follow. The benefits for any Secretary of State for Health are clear; they can distance themselves from poor performance or access to services by directing grievances towards local decision-making and prioritisation by the elected mayor and his or her delegates, rather than an overall lack of central funding, which in a time of austerity must be attractive for a politician of any denomination. Those in Manchester responsible for delivery clearly understand this, which makes it a truly courageous undertaking, but as fans of ‘Yes Minister’ will recall: “a controversial policy will lose votes, whilst a courageous one will lose the election.”
— Paul Bird, CLAHRC Head of Programme Delivery (Engagement)