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NHS ‘Devo-Manc’ is thin end of the wedge

Dara O’Cogaidhin

The NHS ranks consistently among the top three priorities voters care about. Yet a recent policy, which has barely showed on the political radar of most electors outside of Manchester, threatens to fragment and ultimately destroy the national character of the health service.

Chancellor George Osborne intends to hand Greater Manchester control of the region’s £6 billion health and social care budget. This is the latest and most significant step yet for so-called ‘Devo-Manc’: the devolution of powers to the Greater Manchester Combined Authority (GMCA) that will also give the region control over transport, planning, housing and policing.

No one in Manchester has ever voted for this. On the contrary, when asked two years ago if they wanted an elected Mayor with greater powers, the 2.7 million people of Greater Manchester said no. It seems that because the referendum in Scotland rejected the call for independence, this has ignited a widespread demand for decentralisation.

This is the art of demagogy – to link reactionary solutions to real felt needs and problems, relying on ignorance of their actual causes and covering them up.

Of course there is anger over the growing north-south divide, which has blighted cities like Manchester, not to mention the high-handed approach of the Old Etonians at the core of the Tory party. But devolution of public services without the national redistribution of wealth can only lead to further impoverishment of the poorer regions.

Haven’t Tory cuts to local government funding already led to Labour councils, including Manchester, taking the responsibility for destroying jobs and services since 2010? Indeed this is what Osborne intends. The “Northern Powerhouses” he talks about are more likely to become Northern Workhouses. And Labour will take the blame and the shame.


The 10 councils on the GMCA are currently responsible for social care. From April 2016 they will also control spending on public health, general practitioner services, mental health and acute services and community care.

Lord Peter Smith, chair of the GMCA, says the plan will create an “integrated plan approach” that is “tailored to the needs of people in our area”. But bringing health and social care under GMCA management will not compensate for the massive cuts imposed by the Con-Dem coalition.

Greater Manchester is already in the midst of a highly controversial reconfiguration, in which four to five hospitals are to lose their A&E departments or other acute services. At the last count, the region’s hospitals were running a deficit of £40 million. It’s also expected that the GMCA must pool its health budget with its much smaller social care budget, which has been cut by 12 per cent in real terms over the last four years.

Responding to Osborne’s announcement, Anne Athow of the British Medical Association (BMA) accused the Tories of lobbing a “wrecking ball at the National Health Service”. The BMA has warned that handing over health care budgets to local councils risks creating a postcode lottery, with differing priorities and levels of care between different regions.


Labour’s Andy Burnham argues the resultant danger is the creation of a “two-tier NHS” which destroys the principle of a universal and comprehensive service. Posing as a defender of the NHS, he said Labour would commit an extra £2.5 billion a year to the NHS. This falls well short of the extra £20 billion a year that the Institute of Fiscal Studies estimates that the NHS needs to meet patient demand.

Burnham has also pledged to repeal the Health and Social Care Act that unleashed market competition into the health service. As with British Rail 20 years earlier, the Tories’ plan is to run the NHS down, then parcel it up and sell it off cheap. While socialists welcome Burnham’s pledge to repeal the Act, we also remember New Labour promised to renationalise the railways before the 1997 general election, then did nothing of the sort while in office for 13 years.

We can’t rely on the Labour leadership to save the NHS. The major health service unions, Unison, Unite and the GMB, must demand of the party they fund that Labour offers a cast iron pledge to repeal the Health and Social Care Act, to rip up the crippling Private Finance Initiative deals and other outsourcing contracts, and to tax the rich to pump £20 billion a year into the NHS.

If Labour will not do this, then the unions must break from Labour and pool their funds to launch a new working class party committed to socialism.

In order to press our demands on Labour – and to defend the NHS, whoever wins the election – local campaigns against cuts and closures should link up with union branches now to build a mass movement to coordinate protests and strikes. Health workers need to organise in their unions, forming rank and file networks, to decide what kind of action is effective – and make it happen if the union bosses won’t fight.

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