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Guardian Live: Is devolution a good deal for Manchester's NHS? Guardian Live: Is devolution a good deal for Manchester's NHS?
(3 days later)
We’re told the NHS is at breaking point. A recent report from Quality Watch claims the UK is falling behind many other high-income countries on healthcare, David Cameron is pushing for a seven-day health service and, earlier this week, health secretary Jeremy Hunt caused controversy by calling for NHS consultants to start working weekends.We’re told the NHS is at breaking point. A recent report from Quality Watch claims the UK is falling behind many other high-income countries on healthcare, David Cameron is pushing for a seven-day health service and, earlier this week, health secretary Jeremy Hunt caused controversy by calling for NHS consultants to start working weekends.
Related: Devo Manc: should Manchester be Britain’s first devolved city?Related: Devo Manc: should Manchester be Britain’s first devolved city?
February’s announcement that Greater Manchester would become the first English region to be handed full control of its £6bn health budget from April 2016, was presented by Westminster as a triumph for democracy; Chancellor George Osborne called the move an “exciting development” that would “give people in Manchester greater control over their own affairs”.February’s announcement that Greater Manchester would become the first English region to be handed full control of its £6bn health budget from April 2016, was presented by Westminster as a triumph for democracy; Chancellor George Osborne called the move an “exciting development” that would “give people in Manchester greater control over their own affairs”.
But not everyone agrees. Critics argue that devolution could prove chaotic and lament that the public were never consulted about the plans.But not everyone agrees. Critics argue that devolution could prove chaotic and lament that the public were never consulted about the plans.
To debate the issue, four expert panellists joined Guardian Members at Manchester Central Library to decide whether devolution really is good for our health.To debate the issue, four expert panellists joined Guardian Members at Manchester Central Library to decide whether devolution really is good for our health.
Here’s what they thought:Here’s what they thought:
YesYes
Gross health inequality: Claire Reynolds, a councillor in Tameside, Greater Manchester, argued that the economic disparity between London and Manchester had created a health gap that could only be redressed by bringing the NHS under local control. “Being born in Greater Manchester still means being more likely to experience significant health inequalities and live a shorter life,” she said. Steve Connor representing the Oglesby Charitable Trust agreed, citing a report he recently edited that claims there’s a 17-year life expectancy gap between Manchester and London.Gross health inequality: Claire Reynolds, a councillor in Tameside, Greater Manchester, argued that the economic disparity between London and Manchester had created a health gap that could only be redressed by bringing the NHS under local control. “Being born in Greater Manchester still means being more likely to experience significant health inequalities and live a shorter life,” she said. Steve Connor representing the Oglesby Charitable Trust agreed, citing a report he recently edited that claims there’s a 17-year life expectancy gap between Manchester and London.
Being born in Greater Manchester means being more likely to experience health inequalities and live a shorter lifeBeing born in Greater Manchester means being more likely to experience health inequalities and live a shorter life
Giving control back to people: Connor insisted that devolving NHS powers from Whitehall to Manchester could only be a good thing for democracy. “Imagine how bonkers it would be if we said to Whitehall we didn’t want any control over our own future. I’d rather the people pulling the levers were sat in Manchester than Whitehall so I could find them and knock some sense into them,” he said, to cheers from the audience.Giving control back to people: Connor insisted that devolving NHS powers from Whitehall to Manchester could only be a good thing for democracy. “Imagine how bonkers it would be if we said to Whitehall we didn’t want any control over our own future. I’d rather the people pulling the levers were sat in Manchester than Whitehall so I could find them and knock some sense into them,” he said, to cheers from the audience.
The centralised approach doesn’t work: Reynolds, who has previously worked as an MEP liaison officer at 10 Downing Street, argued that centralised decision making over public services is an inefficient and “fundamentally flawed” approach. “I’ve witnessed senior number 10 advisers lengthily debating the pros and cons of building a new hospital in Merseyside or Tameside before a junior minister pointed out that the Tameside hospital had already been built,” she said. “It is because of farcical experiences like this that I cheered when devolution to Greater Manchester was rushed through this spring.” The centralised approach doesn’t work: Reynolds, who has previously worked as an MEP liaison officer at 10 Downing Street, argued that centralised decision making over public services is an inefficient and “fundamentally flawed” approach. “I’ve witnessed senior number 10 advisers lengthily debating the pros and cons of building a new hospital in Merseyside or Tyneside before a junior minister pointed out that the Tyneside hospital had already been built,” she said. “It is because of farcical experiences like this that I cheered when devolution to Greater Manchester was rushed through this spring.”
Social revolution: NHS England chief executive Simon Stevens has spoken of the need for the NHS to become a “social movement” powered by ordinary people at a local level, a sentiment echoed by the panellists in favour of the motion. “In 2015 it’s completely unacceptable in a city like ours to see a young girl facing 17 years less of life,” he said. “We do need a social movement, a cultural shift. As my friend Tony Wilson once said: ‘This is Manchester and we do things differently here.’”Social revolution: NHS England chief executive Simon Stevens has spoken of the need for the NHS to become a “social movement” powered by ordinary people at a local level, a sentiment echoed by the panellists in favour of the motion. “In 2015 it’s completely unacceptable in a city like ours to see a young girl facing 17 years less of life,” he said. “We do need a social movement, a cultural shift. As my friend Tony Wilson once said: ‘This is Manchester and we do things differently here.’”
Related: Devo Manc: five early lessons for the NHSRelated: Devo Manc: five early lessons for the NHS
NoNo
Private sector influence: Under the terms of devolution, healthcare and social care will be merged under one banner. Dr Kailash Chand of the British Medical Association (BMA) warned this could lead to greater private sector control over the NHS. “The BMA is keen to understand whether the proportion of NHS services being delivered by the private sector is likely to increase. The social care sector is now dominated by private providers and the ability of the NHS to act as a coordinated service continues to be reduced because competition is encouraged between organisations.”Private sector influence: Under the terms of devolution, healthcare and social care will be merged under one banner. Dr Kailash Chand of the British Medical Association (BMA) warned this could lead to greater private sector control over the NHS. “The BMA is keen to understand whether the proportion of NHS services being delivered by the private sector is likely to increase. The social care sector is now dominated by private providers and the ability of the NHS to act as a coordinated service continues to be reduced because competition is encouraged between organisations.”
No democracy: David Fernandez-Arias, a supporter of the Greater Manchester Referendum Campaign for Democratic Devolution, argued there was nothing democratic about plans to devolve NHS powers to Manchester. “These new deals have been done with no public awareness, no public consultation, no democratic engagement, no scrutiny and no impact assessment,” he said, adding that the plans amounted to a “treasury-led fiscal decentralisation” rather than a democratic devolution of powers.No democracy: David Fernandez-Arias, a supporter of the Greater Manchester Referendum Campaign for Democratic Devolution, argued there was nothing democratic about plans to devolve NHS powers to Manchester. “These new deals have been done with no public awareness, no public consultation, no democratic engagement, no scrutiny and no impact assessment,” he said, adding that the plans amounted to a “treasury-led fiscal decentralisation” rather than a democratic devolution of powers.
The real problem is about the prevention of lifestyle diseases, the diet-related diseases...The real problem is about the prevention of lifestyle diseases, the diet-related diseases...
Backdrop of austerity: Fernandez-Arias reminded the audience that local NHS budgets would still be determined centrally amid the backdrop of national austerity. In a deal he compared to the Eurozone bailout programme, Arias explained that local authorities will be required to “unlock” funding by demonstrating to the Treasury that investments have met objectives and contributed to national growth. One retired NHS worker in the audience expressed his scepticism that the plans would help improve the lives of ordinary Mancunians: “What we haven’t heard is how Devo Manc will help to achieve any benefits and reduce health inequalities,” he said.Backdrop of austerity: Fernandez-Arias reminded the audience that local NHS budgets would still be determined centrally amid the backdrop of national austerity. In a deal he compared to the Eurozone bailout programme, Arias explained that local authorities will be required to “unlock” funding by demonstrating to the Treasury that investments have met objectives and contributed to national growth. One retired NHS worker in the audience expressed his scepticism that the plans would help improve the lives of ordinary Mancunians: “What we haven’t heard is how Devo Manc will help to achieve any benefits and reduce health inequalities,” he said.
Flawed NHS model: Dr Chand told the audience that while he is in favour of the principle of devolution, he believes the plans failed to address major flaws in the NHS model. The NHS, he pointed out, continues to prioritise diagnosis and treatment over prevention strategies, with only 2.5% of its budget spent on public health. “We do need devolution but this model will totally forget the real fundamental challenges that the NHS faces,” he said, “The real problem is about the prevention of lifestyle diseases, the diet-related diseases – there’s nothing [in these plans] as far as that is concerned.”Flawed NHS model: Dr Chand told the audience that while he is in favour of the principle of devolution, he believes the plans failed to address major flaws in the NHS model. The NHS, he pointed out, continues to prioritise diagnosis and treatment over prevention strategies, with only 2.5% of its budget spent on public health. “We do need devolution but this model will totally forget the real fundamental challenges that the NHS faces,” he said, “The real problem is about the prevention of lifestyle diseases, the diet-related diseases – there’s nothing [in these plans] as far as that is concerned.”
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• This article was amended on 20 July 2015 to correct a reference to a hospital in Tyneside. An earlier version placed it in Tameside.