Why Labour should welcome health devolution to Manchester

This week’s surprise announcement from George Osborne that £6 billion of health and care spending would be devolved to Greater Manchester has caught Labour (and many in the NHS) off guard.

All the details have yet to be agreed, but – based on the revelations in the Manchester Evening News, it is clear the proposals represent a big offer to the northern powerhouse.

Whatever the outcome of last year’s Scottish referendum, the result was always going to lead to a political debate about the devolution of power and how to resolve the English question. Months of secret negotiations with (Labour) leaders in Greater Manchester and the (Conservative) Chancellor have given some answers to this question.

But the politically astute Chancellor has created a dilemma for the Opposition. Andy Burnham – who has said he was unaware of the plans – criticised the proposals and said if he were health secretary he “wouldn’t be offering this deal”. But of the ten councils that have signed this deal eight are Labour-controlled.

Labour’s Lord Peter Smith, who is chair of Greater Manchester Combined Authority and leader of Burnham’s constituency town hall, said the plans would mean services could be tailored around the needs of people living in Greater Manchester.

This close to the election, Labour cannot afford to be distracted by the process of how this deal was reached, but should welcome it for three reasons.

Devolution is Labour’s agenda to own

Devolution to local government and the regions is rooted in Labour’s agenda for public service reform.

Over a year ago, Ed Miliband called for a new culture of public services where power wasn’t simply devolved to people but to councils. He called for a new layer of public services built around local government and partnerships. This was supported by the Adonis Review which did not cover health, but favoured the establishment of regional combined authorities like in Greater Manchester.

The claim this will take Greater Manchester out of the NHS and create a Manchester Health Service is a red herring. Devolution of NHS decision-making has been a feature of our health service for over twenty years and was expanded under the last Labour government.

Labour should not fear but embrace localism; and accept it as a progressive approach to improving public services.

Is Osborne piloting Burnham’s policy?

Giving Greater Manchester responsibility of health and care spending could prove to be a successful model for Andy Burnham’s vision of whole person care.

At the start of 2012, Burnham delivered his speech to the King’s Fund where he proposed fully integrating health, mental health and social care into a system of whole person care. This, he then argued, should be the responsibility of local government, with NHS organisations as “advisers”.

The challenge for Burnham was the viability of his proposals without another “top down reorganisation”. This has led to a shift in emphasis over the past two years to bringing existing structures together, rather than introducing any major legislative changes.

Andy should be credited for winning the argument over why integration of health and care is a political imperative. Without his personal commitment, I don’t believe we would have the cross-party consensus on the issue as we have today. The proposals for Manchester do not look too different from the vision outlined by Burnham a few years ago.

Labour should welcome this week’s announcement as an indication of why their proposals have been right all along, and criticise the Government for failing to take it forward earlier on in the Parliament.

Praising Labour’s northern powerhouse

Finally, the shadow cabinet should be proud that it is Labour councils that are setting this agenda.

One of the ironies for Labour’s health team is that all ten councils that have signed up to the Government’s deal had been chosen by Burnham in 2012 to pilot his own vision of whole person care.

Labour wants this election to be a campaign about the NHS and why they should be trusted to manage its future. What more evidence could you have of why Labour is most trusted with the NHS, when a Conservative Chancellor is willing to hand over the care of 2.8 million patients to a Labour powerhouse?

Taking ownership of the agenda

There is within Labour (and all major parties) an unresolved debate about localism Are they for greater local control or for a national level of service? Perhaps Manchester gives an opportunity to play out this debate in practice rather than theory.

There are of course many risks and unknowns with devo Manchester. Who will ultimately be in charge? What role will local councilors play in NHS decision-making? How will the NHS balance what is best clinically with what is best politically? What powers will Greater Manchester have to raise extra revenue to meet the financial challenges facing local services? Who will be responsible if services fail?

These questions need to be answered and Labour, as the Official Opposition, has a duty to ask them. But responsible scrutiny should not lead to irresponsible opposition. This is Labour’s agenda and it is Labour councils that are pioneering it. Ten weeks out from the General Election, Labour should not shy away from taking Osborne’s deal as what it is: their own.