Merging and devolution in Manchester, to be feared or welcomed?
Edmund Stubbs, 26 February 2015
Plans to give greater Manchester’s council control of £6 billion of their NHS budget were recently leaked prematurely by the Manchester Evening News and then broadcast nationally. Local politicians and Greater Manchester’s elected Mayor will have control of the region’s health care handed to them in a little over a year’s time.
Existing separate budgets for health and social care will be pooled in the region where they will now be administered by the same body, demonstrating, as some may argue, a step towards the general devolution of healthcare responsibility to local government.
Up to the present, NHS social care has been means tested whereas NHS healthcare is free at the point of delivery for all. Combining the budgets for these services may challenge the principle of free delivery of care to all. If the budget for the NHS healthcare now enters into the spectrum of social care then an allocation of funds to cover non-means-tested services might be transferred to that for the provision of social care according to the recipient’s ability to pay. If such a merger of budgets is to succeed without running the risk of this, councils should be provided with clear guidelines as to how much money should be spent on health and how much on social care.
However, on the positive side, if a patient in Manchester would be better off in hospital than in a social care home of visa versa we can anticipate that movement between the two will be much easier, as there will no longer be an incentive for health or social care administrators to try and ‘offload’ costs onto the other to preserve their budgets. The council will be answerable in the case of either areas going over budget.
This may well have a beneficial effect on patient safety; enabling them to be in the best place at the right time, and might save money by preventing unnecessary and expensive ‘extra’ days in hospital, or even by preventing patients in care having to reach a ‘health crisis’ before they are admitted to hospital.
Countries such as Denmark already have a devolved system of healthcare where responsibility is taken by county councils as to the organisation of, and services available to, local patients. Large hospitals are the responsibility of regional authorities. County council elections are held every four years and healthcare is always, understandably, a major issue of debate. As in the UK, the Danish healthcare system is funded through general taxation but central government imposes regulations, sets attainment targets, and distributes funds to cover care in relation to these; currently a block grant and an activity related subsidy with local taxation adding a small remainder to the budget.
Does it work? Danish healthcare seems to generally perform well, however spending is slightly higher per capita than in the UK, and appropriates slightly more of Danish GDP. According (amongst others) to the recently published Euro Health Consumer Index report, Denmark ranks well above the UK. Though such rankings are often criticised for being too subjective, we can nevertheless see that Danish healthcare works at least as well as that of the UK.
In conclusion it seems that the devolution of healthcare responsibility and some merging of health and social care budgets will be an inevitable consequence of giving local councils full control of health budgets, but this eventuality is not necessarily one to be feared. The initiative has the potential to promote better and more efficient care. Local people might also gain more say in the healthcare priorities of their area. However, with devolution, a redistribution and equalisation of funds around the country will be needed to meet varying local need. If this does not happen we may make worse the ‘postcode lottery’ that presently exists in the NHS, when some areas give better care and make different treatments available than do others.
The situation needs clarification and detailed plans look set to be published in the near future.
Edmund Stubbs, Healthcare Researcher
This has got nothing to do with improving health services and everything to do with fudging the issue of devolution in England. Our political elite are determined that England will not have a Parliament or government to represent her national interests. Labour and the LibDems are reliant on Welsh and Scots MPs for a significant number of their Commons seats and are concerned that an English Parliament and government could seriously upset the UK national political apple-cart by forcing the reduction of the per capita Treasury funding for Scotland, Wales and N Ireland, for example, by reducing it to the the per capita funding for England (that would take around £16 billion away from the Celtic Fringe at present).
As for the practicality of the proposal, it should be ruled out on the grounds that it is not compatible with a national health service. It would be impossible to have such devolution through out the country so inevitably differences in service offered and the rules under which it is offered would arise. The post-code lottery in the NHS would deepen.
There is a further good reason why such devolution is wrong: the quality of both local politicians and their senior officers is generally poor. If anyone doubts this go and attend a few local council meetings and committees. They simply would not be up to the job of administering such responsibilities.