Viewpoint: Dr Kailash Chand: Detail needed on devolution of Manchester's £6bn NHS budget

I was in Manchester Town Hall this morning, where Chancellor George Osborne signed a £6bn NHS devolution deal for Greater Manchester.

Dr Chand: 'You could either see this as a triumph for local democracy or creating risks of a false dawn.' Pic: Michele Jones
Dr Chand: 'You could either see this as a triumph for local democracy or creating risks of a false dawn.' Pic: Michele Jones

It would give the region unprecedented control over its health and social care budget. The memorandum of understanding sets out a ‘roadmap’ for full devolution of powers and budgets to commission services including acute and specialised services, primary care, community and mental health services, social care and public health.

£6bn health budget to be handed to Greater Manchester? It’s an idea with promise: putting the Manchester region in charge of its own NHS, with the freedom to integrate between health and council-provided personal care.

The devil is always in the details

I have always been a champion of merging together 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 always in the details.

A full transfer of responsibility for the NHS budget would be reform on a breathtaking scale . We need to carefully examine the implications of such a revolutionary change. All political parties now recognise the need to address the significant fractures in our care services and the need to integrate, or join up, care.

The current fragmented health and social care services leave patients and family carers confused; undermines standards of care; and leads to huge inefficiencies. Manchester with its complex health needs requires a new perspective on how care is commissioned.  However, any plans to do so would have to be underpinned by clear funding to ensure that an already dangerously over-stretched NHS budget isn’t used to prop up a woefully underfunded social care budget.

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

The NHS has just undergone unprecedented upheaval

These wide sweeping changes will affect the 2.7 million population of Manchester. For the Manchester initiative to succeed we need a fundamental review of NHS and social care finances. We need to look carefully at exactly how they will affect the commissioning and delivery of services, and what the impact on patient care will be. We must also ensure clinicians have a central role in decisions over healthcare, something which was undermined by Lansley’s Health and Social Care Act 2012.

While integrated health and social care with more local decision-making about services would be welcome, it in no way it should dilute or compromise the  core values of free universal healthcare paid by central taxation.

The NHS has just undergone unprecedented upheaval, there must be no more top down reorganisation of our health service and we need to avoid a situation where the NHS moves from being a national to a local political football.

Depending on the detail – and the detail is really crucial and we don’t have that 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 creating real risks of yet another false dawn, when the ink has barely dried on Lansley’s failed NHS act.

* Dr Chand is BMA deputy chairman but is writing in a personal capacity.

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