New health chief to oversee Manchester’s devolved budget

In an interview with HSJ’s sister title Local Government Chronicle, he said the region’s elected mayor will not be responsible for the budget.

Last week the region’s 10 council leaders, 12 clinical commissioning groups, 15 NHS providers, NHS England, chancellor George Osborne and health secretary Jeremy Hunt signed a memorandum of understanding for the full devolution of the region’s health and care services from April 2016.

While it falls short of the total devolution of health budgets in Scotland and Wales, the Greater Manchester agreement combines NHS England’s powers to delegate specialised commissioning and primary care funds to CCGs with the freedoms of NHS bodies to pool budgets and powers with each other and local authorities.

Mr Osborne indicated other areas would need to have an elected mayor if they wanted to win similar responsibilities.

However, when asked how the mayor fitted into the devolution of £6bn, Sir Howard, who is also Greater Manchester Combined Authority’s (or GMCA) head of paid service, said: “He doesn’t at all… it will be the responsibility of the combined authority as a whole.”

When asked who would be accountable for the devolved funding, Sir Howard said: “We have yet to work that through. We have just established the principle that there has to be a chief officer.”

The dedicated role would be a separate chief executive post to the one proposed for the authority, which is to appoint a new senior management team to implement devolution. Sir Howard denied “huge new bureaucracies” were being created.

Sue Derbyshire, leader of Stockport Metropolitan Borough Council, said bureaucracy was a “potential concern”.

Greater Manchester’s health services would remain within the NHS and be “subject to its constitution and mandate”, according to the memorandum, obtained by HSJ. Both CCGs and councils would “retain their statutory functions and their current funding allocations”.

Sir Howard said a health and social care partnership board would be responsible for “shaping the strategic direction” of services in the region from April next year. The board will be made up of representatives from the organisations that signed the deal, as well as regulators, Healthwatch and the Greater Manchester Centre for Voluntary Organisation. A decision about whether the board should be a statutory body will be made in June.

It is proposed that below the partnership board will sit a joint commissioning board - consisting of representatives from the councils, CCGs and NHS England - which would make “decisions about where funds go”, Sir Howard said.

Much of the detail of the deal has still to be worked out, including which services will be commissioned at a Greater Manchester-wide level and which will be commissioned locally, and the governance arrangements for pooled budgets.

While local and national leaders have expressed surprise a health deal materialised within four months of the GMCA’s original devolution deal, Cllr Derbyshire called it a “welcome challenge”.

However, another senior local government source within Greater Manchester likened the deal to “a double edged sword”. They told LGC it could be the “saviour” of services at a time of increased budget pressures, but warned it could also be “a recipe for disaster” and “put back the cause of devolution for decades” if leaders failed to make the right investment and priority decisions.

Controversial decisions on a review of Greater Manchester’s health services, which included proposals that could see some hospitals guaranteed specialist status while others would lose onsite emergency surgery services, are not expected until after the general election. Such decisions would “sit at a Greater Manchester level”, said Sir Howard.