Why NHS devolution is a shot in the arm for local leadership

25 February 2015 -

Greater Manchester must seize with both hands the opportunity to manage its own health services, says our political columnist

Jon Bennett

Well, who saw that coming? If this week’s scoop by the Manchester Evening News is borne out in full when George Osborne speaks this coming Friday, £6 billion of NHS funding will be devolved to Greater Manchester. It’s a game changer for local leadership.

Local councils and health groups seem as surprised as anyone by the move. But while Richard Humphries of the Kings Fund has said this could be “reform at a breath-taking scale” he has also suggested the money could be a poisoned chalice that leaves local leaders grappling with a ticking time-bomb in the shape of underfunded services.

With details still emerging, it would be understandable for Manchester’s civic leaders to keep their counsel until they see the small print – but this looks like an opportunity (or challenge) that has to be grasped with both hands.

Voter turnout in the 2014 elections for Manchester City Council varied by ward between 17% and 44%: a pitiful pattern that’s repeated across the country. When Manchester voted against adopting a City Mayor in 2012, just 25% of the electorate turned out to vote. No wonder there was hardly a whimper when Central Government pressed ahead with a city mayor in any case. People don’t get involved in local democracy. They think local decisions won’t make a difference, and feel national decisions are too far removed from their lives.

But control over NHS budgets changes the debate entirely. If health and social care budgets can be combined, there is a real opportunity to make prevention and cure part of the same conversation. And to connect up short-term interventions with long-term care. The opportunity to think holistically, and to focus on people rather than service silos, could improve quality of life and save a fortune. In the process, the shining prize and looming threat of the much maligned “postcode lottery” will ensure that local decisions really matter. Local engagement in the democratic process has every reason to leap.

Yes, it’s a heavy responsibility. Get this wrong, and swift punishment could follow at the ballot box. Perhaps Central Government really does want someone else to take the fall for a service held together by sticking plaster. But that makes the prize all the greater. Great leaders are remembered for taking on major challenges in difficult times. Local government has proven itself the most efficient part of the public sector with the cuts that have been implemented in recent years. This surprise move is a chance to show that local councils and health teams can meet a different sort of challenge: new responsibility, and new funding. It could be a major boost for local democracy, and something to test the mettle of local leaders – first in Greater Manchester, and hopefully in cities beyond.

Of course, there’s a political motivation. This grand gesture keeps the Conservatives a step ahead of Labour on the question of devolution – and demonstrates the party’s relevance in areas where it performs poorly. But take what you can and sup with whom you must. This could be an exciting opportunity for Manchester.

Jon Bennett is managing director of corporate communications consultancy Linstock Communications.

For more on devolution to Greater Manchester, check out our story on the proposed “super mayor” for the region.