Dr Kailash Chand: Devil in the detail for Manchester plan

The £6bn NHS devolution deal for Greater Manchester would give the region unprecedented control over its health and social care budget.

The memorandum of understanding sets out a plan for full devolution of powers and budgets to commission services. It's an idea with promise, putting Manchester in charge of its own NHS, with freedom to integrate health and personal care.

I have always been a champion of merging health and social care - in my view, that is the only way to provide cradle to grave services while keeping the NHS in public hands - but the devil is in the detail.

A full transfer of responsibility for the NHS budget would be reform on a breathtaking scale. We need to examine the implications of such a revolutionary change.

All political parties now recognise the need to integrate care. The current fragmented services leave patients and carers confused, undermine standards and lead to huge inefficiencies. Manchester, with its complex health needs, requires a new perspective on how care is commissioned.

However, such plans must be underpinned by clear funding, to ensure the overstretched NHS budget is not used to prop up the woefully underfunded social care budget.

This plan involves no new money, does not restore the £3bn cuts in social care, and does not deal with the eligibility contradictions between free NHS services and means-tested social care.

For the plan to succeed, we need a fundamental review of NHS and social care finances, looking at how it will affect commissioning and delivery of services, and its impact on patient care. We must ensure clinicians have a central role in decisions.

Integrated care and more local decision-making would be welcome, but this should not dilute or compromise the core values of free universal healthcare paid for by central taxation.

The NHS has just undergone unprecedented upheaval - there must be no more top-down reorganisation and we must avoid it becoming a local as well as a national political football.

Depending on the detail - which is crucial and which we don't have yet - you could either see this as a triumph for local democracy, championing the fundamental needs of total healthcare as defined by WHO in partnership with clinicians, or as the creation of real risks of yet another false dawn.

  • Dr Chand is BMA deputy chairman, but is writing here in a personal capacity.

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