More cities to control health budgets

Chancellor George Osborne has opened the way for more big cities to take control of local healthcare budgets.

In a speech to Parliament yesterday (Thursday, 14 May), Osborne said that a Cities Devolution bill will be a major feature of the Queen’s speech outlining the government’s programme.

He indicated that the bill will enable major cities to follow Manchester in taking charge of services such as transport, housing, skills and healthcare if they opt for elected ‘metro-mayors’.

Local government experts have said this presents a challenge to cities such as Leeds, Liverpool and Birmingham, which have so-far resisted creating mayoral posts that cover their wider city regions.

However, the government seems determined to drive through the devolution agenda, both to create Osborne’s ‘northern powerhouse’ and to counterbalance increased powers for Scotland.

In addition, a new Core Cities group has called for more devolution and the establishment of a ‘place-based comprehensive spending review’ to create “integrated and devolved budgets for specific sets of services across a place.”

These two sets of pressures make it likely that more cities will take responsibility for health and social care, on the so-called ‘devoManc’ model announced in February.

This will see a Greater Manchester Combined Authority take control of the area’s £6 billion healthcare budget; “working closely” with clinical commissioning groups, but without taking over local trusts.

When the devoManc plans were announced, Richard Humphries, the assistant director of the King’s Fund, said they were a bold way to pursue the health and social care integration agenda that sits at the heart of the ‘Five Year Forward View’ to save the NHS £30 billion by 2020-21.

However, he also told Radio 4’s Today programme that: “It is on the nuclear end of the spectrum and raises all sorts of questions and risks.”

He listed two of the risks as triggering “another reorganisation of the NHS, when it’s barely recovered from the last one” and simply shifting the NHS financial crisis onto another organisation. “If the plan is to give the money to local government, then the words ‘chalice’ and ‘poisoned’ perhaps spring to mind.”

In addition, shadow health secretary Andy Burnham, who is now running for leadership of the Labour Party, warned that implementing similar proposals across the UK could lead to fragmentation of the NHS.

“We could see a ‘Swiss Cheese’ NHS, where some bits of the system are operating to different rules or have different powers and freedoms,” he said in March.

NHS England has supported the Manchester plans by drawing up a draft memorandum of understanding to establish a partnership board to take them forward by the end of the present financial year.

However, IT experts told Digital Health News that the proposals will face many of the same technology problems as other integration projects, including a lack of interoperability between health and social care systems, and a lack of new products to put in their place.

In his speech, Osborne argued that “the old model of trying to run everything in our country from the centre of London is broken” and “it is not good for our prosperity or democracy.” He told cities: “It is time for you to take control of your own affairs.”

He insisted that he would not “impose” the mayor model, but he would not “settle for anything less” than “new, city-side elected mayors” because “it is right that people have a single point of accountability.”

He also said that while the bill would appear in the Queen’s speech: “My door is open now to any major city that wants to take this bold step into the future.”