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Devolving the care cuts will not help to stop them

Plans to merge NHS and social care in Manchester won’t empower patients or carers but drive the market even deeper into health

Issue No. 2449

Tory George Osborne called a new £6 billion plan to merge the NHS in Greater Manchester (above) with the social care departments of ten local councils by April 2016, dubbed “Devo Manc”.

Tory George Osborne called a new £6 billion plan to merge the NHS in Greater Manchester (above) with the social care departments of ten local councils by April 2016, dubbed “Devo Manc”. (Pic: Stacey MacNaught on Flickr)


The election has snapped the main parties out of ignoring the crisis in social care. They are now finally focusing on what happens to patients after they leave hospital, and those who can’t leave because there is no support at home or in the community.

Tory George Osborne called a new £6 billion plan to merge the NHS in Greater Manchester with the social care departments of ten local councils by April 2016, dubbed “Devo Manc”.

It quickly roped in much of the local Labour Party establishment eager for new powers and a chance to create a “Northern powerhouse”. But it is no answer to the crisis. 

“It’s going to be a disaster,” saidCaroline Ridgeway, a long standing former mental health worker.

“A budget about the same size of that of Wales is going to be handed over to unaccountable people. Lots of us are scared of that.”

The Scottish independence referendum opened the door for pushing for devolved powers in England’s regions.

For supporters of Devo Manc, it can seem that putting local Labour-led organisations in charge of services could shield them from Tory-led central government.

But it will also let central government pass the buck for the crisis in funding to a new local health authority.

Dozens of cash-strapped organisations are to be welded together with an expensive new bureaucracy.  When the £6 billion budget proves too small for the job, this new body will slash services.

Meanwhile, health ministers will wash their hands of the problem, saying, it’s a “devolved” matter. 

Services

Caroline said, “They want councils that provide terrible services merged with NHS Trusts that are just as bad. These groups can’t work together because of the way the market has taken over health.

“But it will be the same old people running the new set up.”

That’s not the only way Devo Manc could damage services.

Most NHS treatment is free but councils charge for many services—including care homes and personal care at home. When the distinction between NHS and council services is lost there could be new charges for health treatments.

And because so much of social care is already privatised and of a very low standard it will likely drive NHS community services down too.

Health bosses eager to save cash will look for the cheapest firms, paying the worst wages, to provide services.

Finally, the scheme risks fracturing the NHS. The NHS has across the board standards that are supposed to ensure that patients across Britain get similar treatment.  

Osborne’s endgame is to have eight regional variations of the NHS. When that happens, the very idea of a national health service will have gone.

Every region will have its own goals—but few patients will ever have had a say in setting them.


Labour split over the danger of a ‘Swiss cheese’ NHS

Many Labour councillors and MPs in Greater Manchester seem unable to contain their glee about Devo Manc.

They talked of George Osborne’s announcement as a “defining moment” and “unprecedented agreement”.

The deal struck between them and the Tory baron is about more than the NHS. It includes a host of planning powers including regional transport, skills and housing.

But the sheer scale of the health and social care budget means that local politicians are suddenly going to have enormous budgets to play with—and a sense of power.

Labour’s national leadership seems far less impressed. 

Shadow health secretary Andy Burnham rightly warned of a “two-tier health service” and a “Swiss-cheese effect in the NHS whereby cities are opting out”. 

His worries about the future of NHS may be genuine—but he will also know that public anger at cuts and privatisation are at a high.

Among the unions and many Labour supporters there are already grave suspicions of what Devo Manc will bring.

“Many people at first don’t realise what’s wrong with Devo Manc,” said Caroline.

“There’s a lot of propaganda on the TV and newspapers. But once you explain why the plan won’t benefit ordinary people you can tap into a general distrust of Westminster—and the local politicians who have sold off everything. 

“It won’t be ordinary people having more say about healthcare. It will be Serco or one of the other private firms that are the ones who get the benefits.”

Days before announcing Devo Manc, the same council leaders touting it held a “smart rally” against the cuts they were already implementing, due to the Tories’ slashing of local government budgets.

But if the new plan results in chaos and worsening services, it could well be a Labour-led government, and Labour’s northern councillors that are held responsible.

And an explosion of patient, community and union anger is the kind of thing that gives prospective ministers nightmares.


When do we all get a say?

Supporters of the deal claim it will be more democratic.

But ministers gave no thought to how the public will be able to express their feelings.

According to Wigan Labour MP Lisa Nandy (above), a three-week consultation had only 12 responses—ten of them from council leaders who brokered the deal.


Pay could race to the bottom

The NHS has a national pay structure for staff. This prevents individual bosses from trying to drive down wages and encouraging a downward spiral of conditions.

If the NHS is broken into regional units the pressure to get rid of this national agreement will be immense.

This will make it much more difficult for workers to change jobs, move home or improve their careers through training and experience.


Big bill for the bureaucracy

Devo Manc is supposed to cut costs by eliminating duplication. That’s why it will be run by a new “Devolution Programme Board”.

This is stuffed with NHS Trust board members, councillors and bureaucrats from the Department of Health and NHS England and other paid officials.


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Background Check
Tue 14 Apr 2015, 16:52 BST
Issue No. 2449
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