4 reasons why devolution of NHS budgets is a good idea

The recent announcement that the entire NHS health budget for Greater Manchester will be devolved to local councils is both a triumph for progressive local politics – and an admission by the Coalition Government that the Lansley re-organisation of the NHS has been a catastrophic failure. Some commentators have suggested that this will lead to the break-up of the NHS. I would argue that there are 4 compelling reasons why this move is more likely to guarantee the NHS’s continued survival as a national service, free for all at the point of need.

First, we have an expectation that the NHS will always be able to find the resources to meet ever-increasing demands. As a result, NHS services – particularly secondary care – have become a ‘cost escalator’ from which there appears to be no escape. This was not Bevan’s original intent; he assumed that, once the initial ‘backlog’ of poor physical and dental health in the country had been tackled, the costs of the NHS would decrease over time.

For more than a decade there have been warnings about the future affordability of the NHS unless there was a radical change in mindset. Sir Derek Wanless, the former Chair of NatWest, produced a report in 2004 which said that, unless there was much greater engagement of people in considering their responsibilities around health, the NHS would become unaffordable by 2020. Yet this conversation is impossible to have at a national level, as any changes to the status quo are immediately amplified and politicised through the lens of the media. Quiet diplomacy, not megaphone campaigning, is often needed to bring about change – and this can more easily be achieved by bringing local people into the decision-making processes. Devolution allows this to happen.

Secondly, the NHS does not always achieve value for money or value for society. In April 2013, public health responsibilities were transferred from the NHS to councils. Many feared that budgets would be ‘raided’ to support politicians’ pet projects. Instead, local government has applied scrutiny and rigour to the effective use of public health resources in a way that often seemed absent in the NHS. As a result, many councils have been able to improve the outcomes they achieve for their local communities.

One good example is drug and alcohol treatment services. In Newcastle, we were given responsibility for a service in which one in four patients had been treated continuously for more than four years. In effect, people had been helped to swap one addictive substance for another. There was no thought given for how former heroin users now addicted to methodone could be helped back into work, maintain a tenancy or play a more positive role in society. We are challenging and changing this culture of maintained dependency to ensure people are supported to stand on their own two feet again, rather than become reliant on the state long-term.

Thirdly, people have spoken about the need for integration of health and social care for decades – but it still hasn’t happened to any meaningful extent. As a result we have – in Simon Stephen’s phrase – ‘two leaky buckets’, working in parallel to support people rather than together. The future of public service reform lies not in top-down re-organisations, led by a Secretary of State in Parliament, but in allowing local organisations to work together to identify and support cohorts of people with similar characteristics. T

he Troubled Families programme is an early trailblazer for this, and there are some fantastic examples round the country of how this approach can transform peoples’ lives and save money for the state long term. Reform needs to be led by local needs and circumstances, rather than driven by people behind desks in Whitehall.

Fourthly, the barriers to integration are multiple and varied – but the most significant is that the NHS works under a completely different accountability framework to local government. Foundation Trusts are independent organisations who are encouraged to grow their turnover, but this skews the use of resources towards crisis management and treatment rather than prevention.

There are compelling arguments why a modest shift of resources towards early intervention will not only dramatically change peoples’ lives but reduce costs in the long run. For example, would it be better to spend £1m on providing drugs for people at risk of heart disease – or £1m on encouraging more people to walk an extra mile a day? These are the kind of decisions that are impossible to discuss at the moment, but bringing health and social care together into one system to promote the health and wellbeing of the population makes locally elected politicians accountable for the achievement of better outcomes rather than allowing one part of the system to blame another.

There is no doubt that this devolutionary settlement will give a significant boost to local democracy in Greater Manchester, as residents will take a very keen interest in what their politicians are doing on their behalf.

We have a clear choice ahead of us as a nation. Do we want to have public services that simply respond to ever increasing need and are only there to help people at times of crisis, or do we want public services that work with people to help them achieve their potential and live independently?

Labour must continue to be on the progressive side of these arguments, and devolution allows for local people to be involved in finding local solutions to local problems. This is a value at the heart of the Labour Party, and we must not allow the Conservatives to steal it in their positioning ahead of the General Election.

Nick Forbes is  Leader of Newcastle City Council and Labour & Co-operative Councillor for Westgate Ward