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The D-word

The D-word

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The buzz around the devolution to Greater Manchester may have quietened down but steps have been taken in the county to start pushing plans ahead

Devolution is here to stay. Particularly if chancellor George Osborne’s summer budget speech is anything to go by. “In my view devolution within England has only just begun,” he says, and if his ambition of becoming prime minister is attained his view will count even more.
So what of the moves in the “northern powerhouse,” what has happened since the announcement that the health and social care budget of £6 billion was being devolved to Greater Manchester?
Given that the changes only came into effect on 1 April it is understandable that the impact has not taken full force yet.
What has become apparent is the need for relationships to be built between communities across health and social care.
While most saw, and still do see, the devolution as a positive step, at the time of the announcement some members of the Greater Manchester health and social care community felt their voices weren’t heard. Dr Tracey Vell (pictured above), chief executive of Manchester Local Medical Committee (LMC) and chair of Greater Manchester LMCs outlined the concerns she had on the agreement, made between NHS England and Greater Manchester’s 12 clinical commissioning groups (CCGs), 15 NHS providers and 10 local authorities.
Speaking on behalf of her committee, she felt that GPs weren’t represented when discussions took place – a thought that has also been echoed by other groups, such as practice managers. She says: “We weren’t included at all at the start. I don’t think the city council understood what the LMC was and [what it] represented. They thought that CCGs represented GPs but now there is a growing understanding of what the LMCs do. We are not held by the strings that commissioning
GPs have, or the federations that are pure provider units and don’t represent the whole scope of general practice. Hopefully, we now can have that generic influence on all plans involving general practice.”
It is those plans that have opened up a new set of conversations in Greater Manchester that are supposed to help deliver the hopes of the devolution. Of course, the devolution is still in its infancy but this period of time has allowed for open and frank discussions about what each party feels is necessary to move forward. Vell says: “The biggest thing that’s happening in Greater Manchester is that we are actually talking and meeting with Sir Howard Bernstein, [chief executive of Manchester City Council at Manchester Town Hall], and the senior council at the moment, which is something that’s new. We are really finding our way into health and wellbeing boards where that structure will probably be superseded by devolution in the end.”
While steps have been taken to push forward with the devolution, not a lot has been discussed since the announcement. Given that there are whispers that similar agreements may make there way across the rest of the UK it is understandable that there is a sense of apprehension about it.
How it will affect the rest of the UK is hard to decipher given the unique circumstances in Greater Manchester. The populations’ health and social welfare varies greatly throughout the county. Dr James Kingsland, president of the National Association of Primary Care, and a GP based in Wirral, Merseyside, says: “In Greater Manchester you’ve got Didsbury, Altringham, inner City Manchester and so on, there is a world within a world. I don’t know whether it [the devolution] points to compartmentalising to where areas are focusing on the local issues.” Ultimately, Kingsland, like so many others, wants “a stronger evidence base for this sort of development as opposed to lots of people saying, yes we can have a go at it.”
Devolution elsewhere is expected, perhaps first in Cornwall. Back to the summer budget speech.
Osbourne says, “In the first of our new county deals we’re making progress on a major plan to give Cornwall a greater say over local decisions,” he says.
A mention that was welcomed in the Southwest.
NHS Kernow managing director Joy Youart says: “Cornwall will continue to explore closer integration within our health and social care community.
“This is in line with our ethos of integrating health and social care, empowering local communities to have greater ownership of decisions and resources, tailored to local needs. It could enable more resources to focus directly on local patient care and outcomes.”
She says they’ve already seen benefits of closer working including “increased resilience to peaks in demand.”
 Richard Humphries, The King’s Fund’s assistant director of policy, errs on the side of caution with regards to replication of the model. He says: “I think the Greater Manchester work is great for Greater Manchester. I don’t think it will necessarily work in all parts of the UK because the geography is different, and also I think there is a history in Greater Manchester of good working relationships. They’ve been working on this for a long time, long before George Osborne came up with his idea of a northern powerhouse.
“Relationships have been developing and I think there was a strong consensus among all of the councils and the CCGs in that there are things that they can only do together. However, the devil is in the detail and we don’t exactly know how it will all work in practice. So just how much will they devolve right down to the local level? There is a risk that you might create an additional layer of bureaucracy,” he warns.
With the NHS in great financial difficulty, Greater Manchester has taken on a challenge in a period of uncertainty. However, most agree change was and still is needed.
As Humphries says: “I think there is a large risk that what is being devolved to Greater Manchester is a poisoned chalice. Why? In that while demand for health and social care is rising the money that is in the NHS and councils is shrinking.
“We should be devolving both money and powers to a local level but this is an awful time to be doing it.”
Phillip Blond, director of ResPublica and co-author of Devo Max – Devo Manc: Place-based public services, says: “It’s early days but the signs are very good. I think there is every chance of success and we need [the devolution to Greater Manchester] to succeed. The point is that the current model is failing anyway; we are in the midst of the failure of our health system. Especially for those who are at the bottom of the socio-economic ladder. Our northern cities and towns aren’t going to be able to renew themselves unless we in part fix the mental and physical health of their residents.”
Despite concerns, there are reasons to be hopeful. Greater Manchester recently announced it will be rolling out seven-day access. Ivan Benett, clinical director, NHS Central Manchester CCG, spoke of the county’s ability to push through with the idea. He says: “We were already doing seven-day access before the devolution. By the end of 2015 every patient in Greater Manchester will have access to a similar sort of service. This was going to happen anyway whether there was devolution or not. However, the devolution has provided further impetus, and given us more assurance that we will be able to deliver on that.”
While as yet there haven’t been any headline changes from Greater Manchester, devolution has opened lines of communication and given greater confidence to local leaders in their ability to deliver.

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