The decision to devolve and integrate £6bn of health and social care spending in Greater Manchester raises more awkward questions than it answers
Perish the thought, but I did wonder: was the ground breaking deal to devolve Greater Manchester’s £6bn NHS budget from Whitehall to England’s major “northern powerhouse” (copyright George Osborne) timed to be overshadowed by the latest report on Jimmy Savile’s squalid rampage through our institutions?
Why? Because it raises awkward questions.
That was too devious a thought. It was leaked to the Manchester Evening News 48 hours ahead of Friday’s high profile signing of the memorandum between the chancellor and Manchester’s powerful city bosses, council leader Richard Leese and chief executive Howard Bernstein - the men who have driven its renaissance for 20 years.
‘Local media is so enthusiastic that it has a devolution site to rival its two football teams’
Local media is so enthusiastic that the newspaper’s website has a devolution site to rival its two football teams.
Jeremy Hunt and Simon Stevens were in attendance for the signing and Mr Hunt made all the right noises.
He sees it as “an important step forward for integration and a very exciting opportunity”.
Fair enough, plenty of others think that too, including some Labour analysts and Sue Murphy, deputy leader of the city council.
She wrote that the move reflects Ed Miliband’s commitment to devolved powers and protects Labour’s NHS legacy in the city region of its birth: Nye Bevan opened the first NHS hospital, now Trafford General, on 1 July 1948.
A bit part player
Let’s hope she’s right. But this is a Treasury deal, health a bit part player, and Mr Osborne is as political a chancellor as Gordon Brown in all he does.
In November he forced a deal to give more transport, housing and planning powers to what is known as the Greater Manchester Combined Authority (or GMCA), the 10 sub-regional councils welded into cooperation by Leese-Bernstein in ways that have eluded Birmingham and other mutually wary conurbations.
The Treasury’s price was an elected mayor, which city leaders and voters rejected in 2012 referendums in all but Bristol. Health was barely mentioned and secrecy paramount in the talks led by Bernstein and Treasury official John Kingman.
Suddenly, just 10 weeks before the election, Osborne’s “historic day” is unveiled with no warning or statement to MPs.
Don’t get me wrong. I favour NHS devolution and integration with social care too. But the North West is a key Tory-Labour battleground, Osborne is a local MP. So is Andy Burnham, who sits on a GMCA seat inside Wigan and was kept in the dark. On TV Ed Balls appeared to back Osborne (he doesn’t) while Burnham warned against turning the NHS into “a Swiss cheese” and Boris Johnson demanded the same cheese for London.
‘Outer Manchester boroughs fear city centre bosses and think that real devolution should mean they decide budgets’
Outer Manchester boroughs fear city centre bosses (did a disgruntled council tip off the Manchester Evening News?) and think that real devolution should mean they get to decide budgets, not the 10-council shadow authority now being constructed for the 2016 handover.
What about clinical commissioning groups and GPs’ role, ask some?
Will GMCA’s budget still be underwritten by Simon Stevens’s NHS England or does it sink or swim like underfunded Wales? And can any city get the same package - or do we face a two tier system with poorer, rural areas excluded?
Is it the end of a National health service, as the Daily Mail asked?
Burnham is trying to pin down details but he is not alone. What does the reference to “local section 75 agreements” mean? Permission to opt out of national competition rules, he suspects.
Hasty pre-election politics disguised as high concept policy is always risky. Remember Burnham’s own end of life care plan in 2010, that became the “death tax”. And Osborne’s own permissive pensions reform scares plenty. Me too.
Michael White writes about politics for The Guardian