Devolving NHS budget to Greater Manchester will create a “two-tier health service”, says Burnham

25th February, 2015 6:39 pm

Andy Burnham, Shadow Health Secretary and the MP for Leigh, has criticised devolution plans that will see Greater Manchester gain control over its NHS budget.


The plans mean that by April 2016 local leaders, eventually in partnership with a directly elected mayor for the region (a position George Osborne created, the first election for which is expected in 2017), would have total power over the region’s £6bn health budget.

Burnham has said that although he recognises the hard work of those who have managed to arrange this deal with Osborne, he believes the devolution plans will create a ‘two-tier service and challenge the notion of a National Health Service’.

He told the Manchester Evening News: “If I was health secretary I wouldn’t be offering this deal. My worry is having a ‘swiss cheese’ effect in the NHS whereby cities are opting out.”

Burnham said he thought the current system in some parts of Greater Manchester, where local authorities and GP commissions bodies was a far better approach.  He explained:

 “My policy is based on working through the organisations I inherit, not further reorganisation, driving integration at a local level by local Clinical Commissioning Groups and councils coming together to build services.” 

These comments are likely to put him at odds with some local Labour politicians who pushed for this devolution agenda.

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  • The integration of health and social care is an excellent idea. It has existed in Northern Ireland for decades. What I find difficult to understand is why this, and its wholesale devolution to local government, is being pioneered in Greater Manchester.

    The Conservative Party runs one of the 10 metropolitan boroughs there. Manchester itself has been Lib Dem, although Labour currently holds 95 of its 96 seats, with the only other member being an Independent. Most of the other eight are permanently Labour, and none is currently controlled by any other party. Surely the same number of people, albeit spread over a larger area, could have been found in, say, the Thames Valley?

    But in the course of the present Parliament, “the North”, like “the old working class” and “the traditional Labour vote”, has been elevated to the status of the Soul of the Nation, despite the fact that that would mean that Labour ought properly to have won every General Election since the War. However, the only place in “the North” that they can name is Manchester.

    Unlike the little more than ceremonial office of Mayor of London, which is so part-time and apolitical that even Boris Johnson can do it, the proposed Mayor of Greater Manchester, who in practice would be bound to be Labour, would be the Prince of his City-State, and one of the most powerful individual politicians in Europe, since ultimately answerable to no one between elections. Even the big city mayors of the United States do not run healthcare. There are EU member-states with considerably fewer inhabitants than Greater Manchester.

    Ponder these things.

    • treborc1

      The BBC went to Manchester to ask people what they thought and most of the dozen or so people asked seem to think it was a great idea, some also said they were worried for the reasons behind it.

      So good old fashioned one-up-manship by the Tories.

      • Yes, but there are no votes in it for them. And they are planning to create an enormous, permanent Labour powerbase.

        • Doug Smith

          More likely it will turn out to be an enormous, permanent health disaster zone.

          The Tories aren’t fools. They won’t inflict an experiment like this on their own voters.

        • treborc1

          Then no issues because labour were going to devolve power, I take it that would mean the NHS as well.

          My nurse was here an hour ago when the TV was talking about what happens when the funds run out, one doctor said on TV , he said when a GP now sees an elderly patient sends them to hospital because his home is cold and damp the GP will be able to write out a prescription to have his home insulated done up ready for him coming home, and he will have a carer in place. The nurse said to me fine when they have the money but what happens when it’s a billion short, it will not be the Government in London who will pick up the bill, it will be the council tax payers in Manchester. She said the Tories are are wiping their hands of the NHS.

          To see the results one only has to look at Wales.

  • Charlie_Mansell

    Is Andy Burnham really wise alienating thousands of Labour Councillors, who he might want to be closely working with in whatever role he holds after May?:) He and Lisa Nandy might want to consider this issue a little more. More seriously it is clear that some people have been talking the talk about devolution and health and social care integration but are being caught out when what is on offer is much more than that originally planned at £30 billion. Worth reading these tweets here: and here: Devolution to the English Cities and Counties is not going away after the Scottish referendum and needs to be properly dealt with including a serious offer and sensible process of pilot authorities and good practice development over the next 5 years. If Manchester Labour local authorities have come up with a big deal, then I’m sure us in London – with devolved infrastructure in place already – will also want to move towards that too as an early pilot

  • Robert_Crosby

    Burnham’s right to express concerns and question the Tories’ motives for this. I worry that some prominent Labour councillors’ egos may be blinding them to the Tory agenda. These clandestine discussions about “devolved power” have taken place well away from the public, without a constitutional convention that all can make submissions to and actually without any kind of scrutiny at all.

    • Charlie_Mansell

      The bigger worry is why did some people not see this coming? After all the Tories have played risky on this with a 2 question referendum and Cameron on English votes the day after the referendum. Devolution is not going away with a larger SNP contingent after May. This can of course be a trap or Labour can make the issue its own and break out well beyond the very small £30 billion Devolution agenda it had initially planned.

      • Robert_Crosby

        Good points. I still think the likes of Leese need to proceed with caution and respect the concerns expressed by others in Labour towards what is after all a Tory stunt.

        • Charlie_Mansell

          Fair point. I think in the next 70 days all sides need to talk to each other. The GM authorities need to be clear on what they are negotiating and the Shadow DoH team need to be clear to local authorities how integration involves them as part of the devolution agenda. Perhaps the LGA Labour Group could helpfully encourage discussions over the next month in the run-up to finalising the national manifesto by which time we do need to be clear on this issue. This is not just about Manchester, we have a London mayoral election next year and a devolution offer to London (including health and social care integration) will be an issue for public debate. We also now know the Tories are not going to be the centralisers they were in the 80’s. They have radically changed and we need to have a clear political response to them and the rise of the SNP and smaller parties promoting localist and English agendas

  • Doug Smith

    “a directly elected mayor for the region (a position George Osborne created, the first election for which is expected in 2017), would have total power over the region’s £6bn health budget.”

    Six out of nine hospital trusts in Greater Manchester set to end 2014/15 with deficits totalling more than £40m. This financial burden will be shifted away from central government and onto local government.

    And in response, a mayor who will have no experience of running a £6billion health service and insufficient management resources will need to rely on out-sourcing to the private sector.

    The health requirements of the people of Manchester will become a secondary concern in an experiment which has the primary purpose of driving the NHS, by hook or by crook, into the arms of the private sector while central government washes its hands of all responsibility.

    • Charlie_Mansell

      The big issue is not privatisation. If anything the political sacrosanctness of the NHS will mean locally elected Cllrs will be soon politically pressed by local health campaigners to bring more social care back in house to support the NHS. The big issue is actually incredibly stifling ringfences and the current silos each presided over by separate back offices. Why is it local authority finance departments seem to be much better managed than NHS ones – why not not have the better managed one do the books? The Treasury understands this much more than DoH which is why we now have some all-party agreement with both Osborne and Balls coming out in favour of this. Will we have a Swiss cheese policy? Not really! Not if 2-3 managed pilots in Manchester, West Yorkshire and London go first over the next year or so. Then Andy’s “national roll-out” can follow. After Universal credit a bit of humility from ministers on national roll-outs is probably best

      • Doug Smith

        “the political sacrosanctness of the NHS”

        The NHS is not protected by “political sacrosanctness”.

        If “sacrosanctness” offered any protection Blair and Brown’s New Labour would not have got away with their privatisations and PFI projects. The Tories are now continuing the already commenced drive for privatisation.

        And as someone who has attended CCG meetings I can tell you that the NHS management often hide behind “commercial confidentiality” and ignore pressure from local health campaigners.

        • Charlie_Mansell

          It still exists, no one is seriously proposing health insurance schemes and it got star billing at the Ilympics. it is close to being a national religion. This is all a good thing. CCG meetings are rubbish. They meet during the day and who elects them. Better a public Council meeting often in the evening with all the people up for election so you can really put them under pressure. Doesn’t that sound a bit better for opening up issues like commercial confidentially?

        • Charlie_Mansell

          How many were turning up at PCT meetings in the early 2000’s when these deals were being set up? Let’s be honest most people seemed to be pretty indifferent in going along with a lot of these financing measures when the economy was expanding rapidly. More crucially the Labour government had a 10% maximum private involvement limit on the NHS then, so it was still clearly very public. The bigger change has now come with the Health and Social care Act which allows Trusts to have up to 50% private income – a massive shift endangering the public ethos of the NHS. Andy Burnham when he is also negotiating the inevitable integration and devolution deals with Cities will be also be putting this right by shifting us back to NHS as preferred provider status and rejecting TTIP in the NHS


      It took some time to find a sensible contribution to this debate. The allocation of resources to Manchester is a very fudge-able task and unless Manchester get its own source of local funding Osborne will be handing a nice clean axe to go with the responsibility for health.

  • Malcolm McCandless

    There are currently 4 National Health Services. Scottish, English, Welsh and Northern Irish. Greater Manchester has a greater population than Northern Ireland. Greater Manchester has a higher GDP than Wales. A Greater Manchester devolved NHS is entirely viable.


      Yes if that is what you get but dont ignore the fact that it is a G Osborne proposal not a J Hunt initiative. Osborne – poor at economics but first class in politics. Beware of Bullingdon boys bearing gifts – especially before an election!

      • Dave Postles

        Yes, and this is an example, so please sign the petition.
        Cameron, ‘Where should we start? What’s up there in that North?’
        Osborne, ‘There’s a place called Manchester just north of my constituency, I think.’

        • Sylvia

          Thanks for the link; not seen this one before.

  • paul barker

    Labour reverting to its “Whitehall knows best” mindset. Back to normal.


      Manchester get health, Osborne gets to shoot Labour’s fox but Mancunians get to sort out a big array of unintended consequences (and some intended)!

  • Markham Weavill

    And still Burham wants a statist solution. Will he and the Labour leadership never learn. The British public are sick of the health services and NHS being used as a political football. They don’t want a system adhering to an ideology and vision that is 60+ years old and was built to serve a different demographic.They want a practical solution that deals with their individual unique needs when they become ill or old now and in the future.


      And the answer please on a postcard to A Burnham M.P.

    • Sylvia

      Then why is the NHs top of the polls which ask people their main concern?
      ” their individual unique need” will only be met by going private. Is that what you want??

      • Markham Weavill

        Not particularly. What I, and other people I speak to want, is a service that deals with me as an individual. I don’t want to be passed around from bureaucracy to bureaucracy as an NHS number or have to fight my way through the red tape that clogs up the local care system.
        I was diagnosed with prostate cancer in mid 2013 and as a consequence was seen by a GP and three different hospitals as part of my treatment. On the whole I was treated well. However, there were some problems but no single point of contact to complain to because each hospital was run by a different Trust. I was the carer for an aunt who fell and had to go into hospital and then was moved to another hospital for assessment before going into a care home. The treatment she received was excellent. However, the red tape and hoops that I and the other executor had to jump through to sort out a care home and the payment for it just showed how out of touch the system is with the real needs of both patient and carer.
        At the end of the day what patients want is to receive timely and proper care. Most aren’t really bothered who provides it just that it is available.
        In my opinion Burnham is still stuck in the late 90s, early 2000’s. Demographics, technology and the diseases afflicting society have changed but he still wants a monolithic central command system. Osborne blindsided him as did the Labour leaders of Manchester (probably because he isn’t or wasn’t listening). There may well be difficulties with the proposed system but it’s a more fit one for now and the future.

        • Jack

          If the NHS had been functioning the way it was before Thatcher decided to marketise it, you wouldn’t have been passed from pillar to post as you describe. The NHS wasn’t broken before Thatcher and her ilk got their hands on it and it didn’t need fixing, it just needed adequate funding. The rigmarole that you describe is as a result of the Tories relentless attempts to privatise it. Andy Burnham is your friend not your enemy, he wants exactly what you want. You really do need to take the blinkers from your eyes and truly recognise who are the real enemies of the NHS and who has caused the fragmentation that you have experienced.

          • Markham Weavill

            I haven’t got blinkers on. I read, watch and listen to what Burnham and his team come out with and as I say I hear a team who are still stuck in the past. A centralised, tick box system. Labour talk of localism but fear the consequences. They trust neither the voters nor local politicians and it shows in Burnham’s knee jerk reaction to the Manchester proposal.
            It’s no use blaming Thatcher, there was after her Major and then thirteen years of Labour government. The professionals and think tanks were saying through all those years that there needed to be change because of the demographic and technology changes. Labour ignored them preferring to play politics. Throwing money into an already broken system might paper over the cracks in the short term but it will not answer the fundamental changes in society

          • Jack

            If you can’t see what Manchester has done is another step on the way to fragmenting the NHS then you most certainly are wearing blinkers, either that, or for your own reasons you support NHS privatisation. Manchester’s collusion with the Tory led Government will lead to more and more infiltration
            of the NHS by privateers (yes, pirates) wanting to extract as much profit out of the NHS as possible. Don’t you realise that the NHS is at present under a massive and sustained attack from those who wish to see it in the hands of profiteers? and if it is not stopped, the excellent treatment you admitted you received from the NHS will disappear unless you or your insurance company will pay for it.

            This is not a game the Tories are playing, it is deadly serious and they are determined, no matter how long it takes, to see the NHS in private hands. Thatcher made a start and each and every Tory administration has driven the wedge in a little bit further, being helped in the past, to their shame, by
            New Labour. Manchester’s actions are just the latest in so called ‘Labour’ people helping the Tories to fracture the NHS so that in can be consumed in bite size chunks by their friends.

  • Dave Postles

    I suppose it’s the Tories’ way of divesting the Sec of State from responsibility for the whole service and for irrevocably entrenching the CCGs . CCGs are anathema. Who will represent the hospital medics on these joint boards? Who will represent the patients (unlike the former CHCs, there will be no direct lay representation, it seems). It will be interesting to see what the standing orders have about delegated authority and delegated powers to committees and officers.

  • Charlie_Mansell

    The Socialist Health Association initial view of the proposals:

  • Populous56

    I do worry that MPs such as Andy Burnham and Lisa Nandy (both Greater Manchester MPs) are indulging in knee jerk politics on this and classic example of refusing to let go of centralised power. Ed Miliband has been talking for months on the need for large scale devolution – isn’t this exactly what he meant? And yes it is accountable via a directly elected mayor!


      I understand that Osborne (not Piffles, note) has vetoed a referendum on an elected Mayor!

  • David Pickering

    It seems Ed Miliband has a different outlook from Andy Burnham:

    June 2014 -Ed Miliband: “I know the next Labour Government cannot solve every problem by pulling levers in Whitehall, We can only do it by working with, harnessing the energy, the ideas and the dynamism of great businesses, cities, county regions”

    February 2015 – Andy Burnham: “If I was health secretary I wouldn’t be offering this deal.”

    Looks like Burnham is polishing his leftist credentials with his vested interests in the unions. After all, someone will have to fund his leadership bid when Labour lose in May.


      You need more research because Miliband was not advocating piecemeal devolution. Today Manchester, tomorrow West Midlands and the day after, Tyneside – it’s a top down reorganisation by increments.

      • David Pickering

        You think so? Isn’t it better for decisions to be made closer to the people who use the services? Who knows best was is needed in Manchester, the people of Manchester, or a man sat behind a desk, 200 miles away, in London?

        • RegisteredHere

          I think the worry is that this is piecemeal delegation of selected responsibility in place of democratically-agreed devolution to give the English parity with theScots.

          The Tories (and possibly Labour) can’t risk democratic English devolution because it would inevitably bring up the awkward subject of English parliament(s) and massive loss of power in Westminster, not to mention the likely end of FPTP.

          • David Pickering

            Thats a really interesting idea.

  • Jack

    It’s an absolute disaster for the NHS which will now become the HS – another stage in its destruction. And to know a Labour authority has connived in the destruction of the NHS is galling and shameful. The Tories must have been leaping around with glee when Manchester agreed to these proposals. Leese should be booted out of the Party. Doesn’t he realise that it is no accident that the Tories have chosen Manchester to implement this policy, they’ve seen it as a classic case of divide and rule.

    Who needs the Tories with people like Leese around?

    • barry

      There is simply no prospect of “a destruction of the NHS” in this proposal. It’s a plan to put health outcomes at the centre of what the NHS is about. It also provides devolution which is badly needed in our London-centred state. Richard Leese is an experienced Labour politician, who isn’t going to stand for the NHS being dismembered. And he will be supported by many other Labour politicians in the area who’ve been involved for many months in preparing this scheme. Ed Balls is in favour; I’m confident that most of the Shadow Cabinet is in favour. Perhaps we should round them all up and throw them out of the party!

      • Jack

        Perhaps we should round them all up and throw them out of the party!
        Excellent idea, not a Socialist among them!

        • barry

          What isnt isn’t socialist about this scheme ?Apart from the fact that the Tories suggested it.

          • Jack

            What isnt isn’t socialist about this scheme

            I can’t believe you’ve even asked that question!

            For a start, it will fragment the NHS which will no longer be a national service.

            It will allow the Government to divest itself of responsibility to provide national health care.

            It will enable local authorities to take healthcare away from the NHS and privatise it without blame being placed on the government.

            It will allow the government to strangle funding without suffering the political consequences because it places a fire wall between it and the outcomes.

            In short, the Tories have gone yet another step forward in their ambition to destroy the NHS and naive ‘Labour’ politicians have assisted them.

          • barry

            Don’t take it from me, listen to the Socialist Health Association :

            “We welcome the announcement that control of the NHS budget is to be handed to Greater Manchester authorities and look forward to working much more closely with these elected local authorities. Under the right conditions this could be an opportunity to ensure that our Manchester Health Service brings much greater benefits to patients and communities.The MHS should be much more democratically accountable than the NHS has been in the past”.
            Perhaps the Socialist Health Association packed with health professionals aren’t proper socialists and their affiliation to the Labour Party should be rescinded immediately!
            When, within a few days, this is welcomed by EM should we also throw him, the Shadow Cabinet and all of the PLP out as well?

          • Jack

            If you are going to quote what others say, please quote it accurately.

            But anyway, you also say:

            Perhaps the Socialist Health Association packed with “naive” health professionals aren’t proper socialists

            It’s tempting to ask could these be the Champagne Socialists that we often hear about?

            Rather than those at SHA’s dinner apparently welcoming the proposals, I prefer the response in their comments section:-

            Mervyn Hyde:
            “Does it not occur to others that this is more fragmentation, not the devolution that it pretends to be?

            Think of Funding and local councils, last year our local county council was forced to make £75 million in cuts after year after year of cuts previously.

            Does anyone really believe this is anything other than further dismantling of our NHS, and why has our NHS been so successful in the past, until these Neo-liberal politicians appeared, telling us things would be more efficient in
            private hands?

            Isn’t it time people woke up in this country?”

            Well said Mervyn.

  • gavin

    There are different NHS models in the UK. In Scotland the First Minister can be questioned in Parliament by Scottish Labour ( then get pelters from the heavily biased BBC Scotland ) about a man in hospital who had to wait several hours to get a blanket.
    Meanwhile in England, Andy Burnham could preside over an NHS where thousands of people died early deaths in several hospitals, related to the treatment they received in those hospitals, yet Burnham remained in post, and is still Labour Health spokesman.

  • RWP

    How does Burnham’s view sit with EdM statements about wanting more de-centralisation and devolution of power to local authorities?

  • Tommo

    Sometimes other parties have good ideas as well !!!

  • Sylvia

    I’m confused by Andy’s reaction. He has said he wants to see a joined-up health & social care everywhere. OK he means nationally but you have to start somewhere.
    In this case it looks as though Osborne / Tories have realised it’s a good idea & got there first.

  • Ian McCartney

    Firstly declare an interest I am chair of Healthwatch Wigan and represent all Healthwatch
    Organisations ax Gt. Manchester as a independent member of the Greater Manchester
    Combined Authority’s Health & Wellbeing Board and HW rep on Wigan Council’s
    Health and Wellbeing Board and both the adult and Childrens safeguarding Boards.
    However my contribution to this debate is as a member of the Labour Party .
    I attended the event in Manchester Town Hall this morning . Over a period of 24 hours
    orgs in Gt. Manchester’ s health and social care communities were being invited to a
    “consultation” on the Health and Social care aspects of Devo Manc. The venue was
    to be released hours before event and you would be required to show photo ID . I took
    my passport and advised of the venue unofficially around 22.00 Thursday night.
    In fact we were invited under false pretences. No consultation we were recruited as a
    passive backdrop to a Tory re-election event introduced by a Labour Council Leader
    and chaired by another Labour Council Leader. We witnessed the signing of a MOU
    which was given out just before event commenced. We were told the document did
    not relate to funding present or future! despite money mentioned in the documents
    £6bn. Short statements followed by Osborne, a CCG Chair, a Chief Executive of a
    Foundation Trust , Simon Stephens and finally s.o.s Hunt. Sir Richard Lease then
    immediately thanked us for coming and supporting the MOU and its contents. With
    that they left the room by a side door and disappeared. No Questions , no comments
    allowed. This small cabal had achieved their Aim of casting the debate on both devolution
    and health and social care as modern tory thinking. Whilst this “event” spoon fed to
    chosen members of the press including the guardian. Wigan’s Evening Post was
    for the second time in three days reporting the day to day crisis of funding health and
    social care services in Wigan by way of a report sent to the council cabinet . Healthwatch
    despite our statutory rights and membership of the Health & Wellbeing Board left of the
    distribution list. Since the original Devo Manc agreemeant we have seen Manchester City
    Council cutting resources in this area of activity. This issue huge as it is should not be
    judged simply as a major one off much needed reform of health and social care.
    Be clear these were decisions taken in secret with no involvement of communities ,
    patient and carer orgs., no engagement with the vast majority of elected councillors,
    Even most cabinets members were not trusted enough to informed of negotiations.
    You would have thought local MPs NO, Andy Burnham kept abreast of discussions NO,
    and despite our statutory role no attempt to include Healthwatch. The NHS now branded
    MHS will be handed over lock, stock and barrel to an unelected Mayor , re-organised
    acute services including hospital reconfigurations, and no commitments to deal with
    the deliberate chronic underfunding of services across the County and the NW Region.
    Our Health and Social Care System was this morning put into “intensive care” Services
    being recast for the many by the few. For me personally it is a tragic missed opportunity
    to engage our citizens and frontline staff in the creation of well funded, stable, and
    coherent health and social care services. Devo Manc is not devolution as we know it or
    understand it. It is a back room deal hammered out in secret by unelected officials and
    unaccountable local leaders. An unelected mayor in charge of our NHS, Housing, Transport,
    and much more besides. An unelected scrutiny group. It’s a beggar my neighbour
    strategy causing divisions across our heartlands weeks before a general election. You
    couldn’t make it up, well we just have in Gt. Manchester

    • Dave Postles

      Thanks. I hope that everyone reads your contribution. It should be copied into every thread about the NHS here. Moderators please take note.

      • Doug Smith

        It should be featured as a headline article.

        • Dave Postles

          Yes, you are totally correct. There was another letter in The Guardian which I shall post here soon.

    • Jack

      Thanks, you have just blown up the lie that this move was supported by everyone.

      We now await the news that Judas Leese is to become a member of the Tory Party. I’d settle for him being an ex member of the Labour Party.

  • Donald Stavert

    Andy is wrong on this one more devolution please … been promised it for so long now and locally controlled integrated services are the way forward

  • Dave Postles

    Here is a letter from The Guardian letters page. I apologize if this infringes copyright.

    ‘There may be doubt as to whether or not devolving NHS budgets to
    local authorities might somehow undermine the concept of a national
    health service (Greater Manchester to control £6bn of health and social care, 26 February). I may be able to help from personal experience as a former clinical director of an NHS drug and alcohol service.

    The budget for drug and alcohol treatment in my area was devolved to a
    (Labour) local authority in 2008 by a (Labour) government committed to
    encouraging local services for local people. Provision became
    immediately subject to local authority procurement rules which dictate
    that all services should be put out to competitive tender every three
    years. As a result, a half of my doctor, nurse and social worker
    colleagues, many of them with more than 20 years’ experience in the NHS,
    were transferred to the private sector, under Transfer of Undertakings
    (Protection of Employment) Regulations, in 2011. At the next round of
    competitive tendering in 2013, a further 20 or so colleagues were made
    redundant as the NHS trust again lost ground to commercial interests.

    This pattern has been replicated across the country; the NHS is left
    delivering substance misuse services in no more than a handful of areas.
    What was once a vibrant and effective sector of the NHS built on a
    stable and committed workforce is now a patchwork of local
    private-sector providers who are subject to recommissioning every three
    years. Morale among the workforce has never been lower and services rely
    in the main on the deployment of poorly paid agency staff. Those of us
    lucky enough to have found a way out watch with great dismay from a safe
    Is this what we want for the future of health provision in Manchester?
    Name and address supplied’


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