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Why we find the idea of a locally delivered national service so challenging

Central Manchester University Hospitals (Credit: by uklabour on Flickr)

Central Manchester University Hospitals (Credit: by uklabour on Flickr)

Phil Swann, Si Managing Director writes

Last week’s signing of the deal to devolve responsibility for an integrated £6bn health and care budget to Greater Manchester is profoundly important for both the health service and local government. But two aspects of the response to the move show how much more there is still to be done to make the case for localism.

First, the concerns expressed about the implications for the National Health Service (with the emphasis on the first of those three words). Labour’s shadow minister Andy Burnham warned about the creation of a two-tier service. And there was a debate on Twitter about whether the developments in Greater Manchester signalled the renaissance of local government or the dismantling of the NHS.

There is clearly still a reluctance in some quarters to come to terms with what the idea of a national service locally delivered really means. The fact is that what works in one place will not necessarily work in another, and the type of devolution now being offered in the North West is essential if we are to secure improvements in health and wellbeing. It is the best response to the postcode lottery, not the cause of it.

Sadly it is not only national politicians who fall into the one size fits all trap. The combined authority model clearly suits Greater Manchester, but it is not appropriate everywhere. This model is certainly not appropriate for some of the shire areas I am currently working in. Despite this the stampede to create combined authorities continues. Just as we need more than model for health and social care at a local model, we need a range of governance arrangements which can respond to the opportunities presented by devolution in ways in which suit local circumstances.

Second, it is significant that reports of the signing ceremony made it clear that local leaders went out of their way to say that it was not a local authority take over. The fact that it was felt to be necessary to say this speaks volumes. There is something in our political culture which makes the notion of shared responsibility and shared leadership difficult to contemplate let alone deliver. It lies at the heart of dysfunctional central – local relations, it explains why county and district councils find it so hard to collaborate and it is infecting moves towards the integration of health and social care.

There is clearly an enormous amount of detailed work to be done to deliver the deal that was signed in Manchester last week. But it is equally important to devote effort to changing our political and organisational cultures. If we don’t do so there is a real danger that Andy Burnham’s fears will prove to be justified and this will be seen to have been just another bout of tinkering with the organisation of the NHS.

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