George Osborne and David Cameron speak to business leaders at the AQL centre on February 5, 2015 in Leeds. Photograph: Getty Images.
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Osborne's dramatic Manchester NHS plan is a dangerous distraction

The Chancellor's politically-motivated project undermines the goal of the national integration of health and social care. 

The most significant political story today is George Osborne's confirmation that he intends to hand Greater Manchester control of the region's £6bn health and social care budget (a quarter of total government spending in the area). Never in the history of the NHS has there been such devolution in England. The announcement was due to be made on Friday, during a visit by Osborne to the area, but the Chancellor's plans were foiled after the Manchester Evening News got hold of a draft "memorandum of understanding" between the region's councils and the Treasury. 

This being Osborne, who remains the Conservatives' chief electoral strategist, the politics are crucial. He has framed the move, which would take effect from April 2016, as part of his drive to create a "northern powerhouse", a project with the political aim of decontaminating the Conservative brand in that region (one inspired by Osborne's special adviser Neil O'Brien, the former director of Policy Exchange). The Tories are also hailing the proposed integration of health and social care spending as evidence that they are making the running on a cause that Andy Burnham, the shadow health secretary, has long championed. 

But if the politics are clear, the policy is not. By promising Greater Manchester control of health spending, the Conservatives have set a precedent that several other areas will want to follow (Tessa Jowell, the Labour London mayoral candidate, was swift to demand equivalent powers for the capital). In so doing, they have driven a coach and horses through Labour's proposed national integration of health and social care. As Burnham noted in his response, the resultant danger is the creation of a "two-tier" NHS which destroys the principle of a universal and comprehensive service. In the middle of the greatest funding squeeze in the NHS's history, Osborne's "devo Manc" project, which would likely necessitate another reorganisation, risks being a dangerous distraction. Under Burnham's alternative vision, health and social care would be nationally integrated (producing up to £6bn in savings) with individual local authorities and GP commissioning bodies working in harness to build new services. 

Osborne's proposal of stand-alone devolution to Manchester resembles an answer in search of a problem. Worse, it threatens to create new dysfunctions. At the last count, the region's hospitals were running a deficit of £40m. Who will pick up the bill in the event of a crisis? Though the Conservatives will protest otherwise, the move risks being the first step in the ultimate unravelling of a truly national health service. 

George Eaton is political editor of the New Statesman.

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Air pollution: 5 steps to vanquishing an invisible killer

A new report looks at the economics of air pollution. 

110, 150, 520... These chilling statistics are the number of deaths attributable to particulate air pollution for the cities of Southampton, Nottingham and Birmingham in 2010 respectively. Or how about 40,000 - that is the total number of UK deaths per year that are attributable the combined effects of particulate matter (PM2.5) and Nitrogen Oxides (NOx).

This situation sucks, to say the very least. But while there are no dramatic images to stir up action, these deaths are preventable and we know their cause. Road traffic is the worst culprit. Traffic is responsible for 80 per cent of NOx on high pollution roads, with diesel engines contributing the bulk of the problem.

Now a new report by ResPublica has compiled a list of ways that city councils around the UK can help. The report argues that: “The onus is on cities to create plans that can meet the health and economic challenge within a short time-frame, and identify what they need from national government to do so.”

This is a diplomatic way of saying that current government action on the subject does not go far enough – and that cities must help prod them into gear. That includes poking holes in the government’s proposed plans for new “Clean Air Zones”.

Here are just five of the ways the report suggests letting the light in and the pollution out:

1. Clean up the draft Clean Air Zones framework

Last October, the government set out its draft plans for new Clean Air Zones in the UK’s five most polluted cities, Birmingham, Derby, Leeds, Nottingham and Southampton (excluding London - where other plans are afoot). These zones will charge “polluting” vehicles to enter and can be implemented with varying levels of intensity, with three options that include cars and one that does not.

But the report argues that there is still too much potential for polluters to play dirty with the rules. Car-charging zones must be mandatory for all cities that breach the current EU standards, the report argues (not just the suggested five). Otherwise national operators who own fleets of vehicles could simply relocate outdated buses or taxis to places where they don’t have to pay.  

Different vehicles should fall under the same rules, the report added. Otherwise, taking your car rather than the bus could suddenly seem like the cost-saving option.

2. Vouchers to vouch-safe the project’s success

The government is exploring a scrappage scheme for diesel cars, to help get the worst and oldest polluting vehicles off the road. But as the report points out, blanket scrappage could simply put a whole load of new fossil-fuel cars on the road.

Instead, ResPublica suggests using the revenue from the Clean Air Zone charges, plus hiked vehicle registration fees, to create “Pollution Reduction Vouchers”.

Low-income households with older cars, that would be liable to charging, could then use the vouchers to help secure alternative transport, buy a new and compliant car, or retrofit their existing vehicle with new technology.

3. Extend Vehicle Excise Duty

Vehicle Excise Duty is currently only tiered by how much CO2 pollution a car creates for the first year. After that it becomes a flat rate for all cars under £40,000. The report suggests changing this so that the most polluting vehicles for CO2, NOx and PM2.5 continue to pay higher rates throughout their life span.

For ClientEarth CEO James Thornton, changes to vehicle excise duty are key to moving people onto cleaner modes of transport: “We need a network of clean air zones to keep the most polluting diesel vehicles from the most polluted parts of our towns and cities and incentives such as a targeted scrappage scheme and changes to vehicle excise duty to move people onto cleaner modes of transport.”

4. Repurposed car parks

You would think city bosses would want less cars in the centre of town. But while less cars is good news for oxygen-breathers, it is bad news for city budgets reliant on parking charges. But using car parks to tap into new revenue from property development and joint ventures could help cities reverse this thinking.

5. Prioritise public awareness

Charge zones can be understandably unpopular. In 2008, a referendum in Manchester defeated the idea of congestion charging. So a big effort is needed to raise public awareness of the health crisis our roads have caused. Metro mayors should outline pollution plans in their manifestos, the report suggests. And cities can take advantage of their existing assets. For example in London there are plans to use electronics in the Underground to update travellers on the air pollution levels.

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Change is already in the air. Southampton has used money from the Local Sustainable Travel Fund to run a successful messaging campaign. And in 2011 Nottingham City Council became the first city to implement a Workplace Parking levy – a scheme which has raised £35.3m to help extend its tram system, upgrade the station and purchase electric buses.

But many more “air necessities” are needed before we can forget about pollution’s worry and its strife.  

 

India Bourke is an environment writer and editorial assistant at the New Statesman.