Untangling the knitting

Normanwarner4x3.jpgNorman Warner on the lack of clarity in the government’s plans for NHS devolution to Greater Manchester and beyond

The Government is in danger of carelessly wrecking two good ideas – its English devolution Bill and its Greater Manchester agreement on devolution of NHS budgets and responsibilities.  These come together in the Cities and Local Government Bill currently before the House of Lords. Peers scrutiny of the detail of Bill however, has revealed how poorly Ministers have thought about implementation. In particular, how the new Bill fits in with the 2012 Health and Social Care Act. There would be a cruel irony if Lansley’s legacy derailed George Osborne’s Northern Powerhouse aspirations and NHS England’s Five Year Forward View, both of which I am a fan of.

The Lansley Act has a myriad of provisions that give the Health Secretary endless opportunity to intervening in the running of the NHS, despite its author’s claim to be freeing up the health service from day-to-day political interference. Reconciling this with the government’s new enthusiasm for English devolution and the decentralising thrust of the Forward View is a difficult trick to pull off, but could work if done transparently. Instead, Ministers are using smoke and mirrors with locally agreed memorandums of understanding and order-making powers in the Bill while failing to restrain any of the centralising provisions of the 2012 Act.

The result is that the devolution knitting is becoming increasingly tangled, as Lords Minister Baroness Williams of Trafford sticks to an official brief which totally fails to acknowledge the fundamental incompatibility of the new legislation and Lansley’s legacy. Although not easy, it should still be possible to put on the face of the CLG Bill a clear process for delegating NHS responsibilities locally via NHS England; and at the same time moderate the Health Secretary’s powers to interfere once a local scheme of delegation has been agreed.

None of this means that the Health Secretary should not be able to intervene if the local agreement is failing or changes are made by agreement at any future point. There could be a set of statutory requirements to be met before the agreement is signed, so it is in the best interests of the health and care of the population served, delivers quality services and secures health outcomes. Nobody is suggesting that we should take the ‘N’ out of the NHS. Indeed the new local entities exercising the delegated responsibilities would have to abide by virtually all of the duties on the Health Secretary and NHS England set out in the Lansley Act.

What would be guaranteed is that local interests could get on with transforming their local NHS in the way permitted in their agreement, without a diet of unsolicited advice and instruction from Whitehall. If they decided after local discussion to replace 100 inpatient beds with a new range of preventative and community-based services that would be a matter for them. Unlike now, where a Health Secretary might respond hyper-actively to cries of anguish from opponents of the change.

The government needs to have the courage of their devolution convictions and abandon the muddle they are in. This requires them to place on the face of the Cities and Local Government Bill a transparent process for securing devolution of ‘NHS’ responsibilities as part of a wider devolution agenda without removing the ‘N’. It should be possible to frame a way of doing this in a non-partisan way politically before the Bill leaves the Lords but only if Ministers open themselves up to this possibility. Many on the Labour benches and across the House stand ready to help.

Lord Norman Warner is a backbench Labour Peer and a former Health Minister

Published 30th June 2015

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