NHS devolution: the route to tackling health inequality?
The announcement that the £6bn NHS budget in Greater Manchester will be devolved to the city region has taken many by surprise.
The government has already devolved £2bn of spending to the city region. This proposal (the details of which still need to be worked up) is worth three times that amount, devolving nationally controlled structures such as hospitals and GPs to merge with local support and community care services. Greater Manchester will create a new ‘health and wellbeing’ commission to control the flow of money across the system, and to create links between primary and community and residential care.
This development is akin to some of the recommendations by the Due North inquiry into health inequalities. This independent inquiry, administered by Cles and commissioned by Public Health England, was designed to provide fresh insights into policy and action to tackle health inequalities both within the north of England and the rest of the country. It incorporated a panel of experts from economic development, public health, local government and the voluntary and community sectors.
The review argues for a more community-orientated model of primary care that fully integrates support across the determinants of health. It also specifically recommends ‘a review of current systems for the central allocation of public resources to local areas, including systems for the allocation of NHS resources to maximise their impact on reducing health inequalities’.
This is a welcome move but the extent to which it will
herald a genuine improvement in health outcomes is uncertain
What could not have been foreseen was something on the scale and pace of change we see with this week’s announcement.
A key opportunity the new plans could bring is to create a much more integrated and joined up system between local government and health. It could provide a catalyst in Greater Manchester, which could be replicated elsewhere, to forge strong links between health and economic development, housing, employment and investment in prevention.
There is also the potential to align health and social care more strongly. Forging local links between the two provides an opportunity for enhance health outcomes and provide genuine local solutions. Localised decision making could result in less focus on demand management and more focus on managing demand more effectively.
Despite the potential of this policy, there are some major questions and fears that need to be considered. Firstly, this is a huge shift that has been sprung on the local population. Will they be consulted in how the mechanics of this work?
Secondly, it could advance the break up of the ‘national’ health service. Could we be moving to an even greater patchwork quilt of different priorities in provision and spending depending on where you live? These are valid concerns that need to be addressed.
It could also be argued that devolution of health will merely result in decentralising national problems to the local level. There are significant deficits within Greater Manchester’s NHS (hospitals are reported to be running a deficit of £40m) on top of social care cuts within local government. Can two under-resourced systems be fused together in such a way? Devolution of powers cannot make up for the long term underfunding of vital services within an environment of austerity.
There needs to be fairer funding for the NHS and councils to meet the needs of local people to avoid another case of delegating power without the appropriate resources to deliver. This is a critical point, and partly leads us to local tax raising and retention powers, but that argument is for another day.
We need more details about how devolution of health will work, but it could be an opportunity to ensure that greater benefits are provided to both patients and communities. In an era of austerity, with many more cuts to come, it is a welcome move but the extent to which it will herald a genuine improvement in health outcomes is for now uncertain. There is still much work to be done.
I was involved in the health sector and local government for many years CHC member, PCT member and lastly governor of The Christie and welcome this move to reduce the barriers between health and social care. This article plays heavily on the negative points and is somewhat lukewarm in describing the advantages. Let us be honest about the layers of vested interest in the health sector not least in the hospital sector. Funding has disproportionately been skewed towards the secondary providers because they have the clout. Health outcomes are not determined by the end of the process but the beginning. Housing, education and employment or lack of are better indicators than hospital successes. Primary care alongside preventative care have long been the Cinderellas. It is time to redress the balance. Pumping more money into hospitals does not do this. I prefer the positive approach rather than the timid one presented in this article.
Val,
Thanks for your comment; that’s a fair point you make. We are generally positive about this, and as we say, it represents a real opportunity to improve health outcomes, and create a much more integrated locally responsive system. There are challenges and questions that will need to be addressed, although Greater Manchester should be well positioned to respond positively to this. We look forward to seeing how this progresses.
I’d put the question the other way round…in that the national health service has not managed its priorities to tackle health inequalities and neither has it ever shown a willingness while managed from London to integrate treatment and care,not to mention prevention….unless it could have absorbed social care into the national machinery which would have been a disaster. I agree Val. I’m really sad it didn’t happen while I was around!