DEVO MANC: future for the NHS?
£6 billion of NHS care is to be merged with Social Care Commissioning and given to the new Greater Manchester Combined Authority, run by a mayor.
Taking the ‘National’ out of the NHS starts with Greater Manchester but could spread everywhere. ’Devo Manc’ is another top-down reorganisation with no consultation. How can we defend national pay, terms and conditions if budgets are controlled locally? How will merging two underfunded market-ridden commissioners help to improve social care, produce better outcomes for patients, reduce bed blocking, give local people a greater say in NHS or social care? Greater integration of health and social care is good in theory. But without adequate funding (£6 billion won’t cover the area’s health and social care needs) and proper planning, this proposal is mainly an illusory shift of power and a real shift of blame.
Lack of clarity and funding
Trade unions should demand more information about the impact for services and staff, and proper consultation before deciding to support this plan. The details are unpublished, and may not be legal, but warning signs are clear:
- Health care and social care problems will NOT be solved by another expensive top-down reorganisation.
- £1.2 billion (20%) has been cut from the Greater Manchester health budgets by this government.
- 40% has been cut from council budgets leading to 25% cut in social care. Nationally nearly a million fewer elderly people in England get home care now.
- Devo Manc says public health, prevention and health promotion are crucial. Yet Manchester City Council has just implemented the government’s £90m cuts in public health funding for mental health and health and wellbeing services. Hundreds of staff are losing their jobs, and services are being slashed or closed.
- Greater Manchester NHS want to downgrade and close 5 A+E departments.
- The proposals say the “role of third sector and private sector providers … remains to be determined.” Social care has already largely been privatised—which means 15 minute social care visits by people on less than the minimum wage (because staff are paid nothing to get from one client to another).
- Joint Commissioning of Mental Health services has not improved them. Mental health is 27% of health need but gets only 13% of health funding. Many unwell users are discharged from services, with too few beds even for people who need to be sectioned, and there’s a huge increase in use of private hospitals.
- With a stated commitment to no increase in total costs, the plan will pass responsibility – and blame – for cuts and privatisation to local authorities.
What about democracy?
Nine of the ten Greater Manchester boroughs voted in 2012 against having a mayor. No-one was consulted over Devo Manc, so the NWTUC voted to support the call for a referendum—although UNISON officials voted against. The ten Greater Manchester councils—mostly Labour controlled—are disregarding their electorate, staff and trade union representatives. Their power play with George Osborne apparently by-passed Andy Burnham, a local Labour MP and shadow Health secretary. He warns that the proposals could break up the NHS and lead to inconsistency across the country.
UNISON and the other unions in the NHS and local government were not involved in the discussions either. At the UNISON NW region meeting in May and at UNISON National Delegate Conference in June, members from branches in Greater Manchester expressed concern about the way that the deal had been done, and what it could mean for union members and for services. Tony Lloyd, a former Manchester MP and Greater Manchester Police Commissioner, has been confirmed as interim mayor. He has not been elected to that position – there will be an election in May 2017.
A ‘Health and Social Care Devolution Programme Board’ has already been set up in shadow form, and will take full control from April 2016. A new tier of ‘City Region’ bureaucracy will not ‘democratise’ the NHS.
The elected Greater Manchester councils and the government have no mandate for these far-reaching changes to the NHS, affecting all of us.
Also see the Greater Manchester Keep Our NHS Public website for more concerns about Devo Manc: http://keepournhspublicgmcr.com/2015/07/02/devo-manc-and-the-nhs/