The deal to devolve NHS spending to Greater Manchester has split Labour (Photo:Getty)
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Real devolution has to come from public consent, not Whitehall diktat

Devolution has to be about more than transferring power from one unaccountable structure in London to another in Manchester, Lisa Nandy argues

The Greater Manchester devolution deal took a lot of people by surprise. Negotiated behind closed doors and announced to the media, it has led to heated debate among the public, charities and community groups, many local councillors and Members of Parliament. Two years ago, in a public referendum Manchester residents had rejected a Mayor but now with a new deal on the table - much more significant and covering the whole of Greater Manchester - the public have been cut out of the conversation.

But, as ministers told me when I asked questions about this in Parliament, the public will have a say – through the ballot box. Only, as it turns out, they won’t. Not until 2017 at the earliest, although the Mayor, who will be appointed in June, can serve until 2019 before an election must be called.

In the meantime we’ve learnt through the media that £13.5m of public money is being spent on transforming Manchester Town Hall’s bureaucratic structure ready for the appointed Mayor, or “eleventh leader” to start work immediately. Ministers have confirmed to me that no thought has yet been given to public scrutiny or involvement. And a consultation to consider the impact of these huge, sweeping changes on local communities ran for just three weeks, wasn’t advertised and had only 12 responses, 10 of them from the local authority leaders who brokered the deal in the first place.

Despite the fact that it closed just a week ago, the consultation didn’t even mention the NHS once let alone the transfer of responsibility and billions of pounds of NHS funding that was announced and signed by George Osborne today, just weeks ahead of the general election. Even if ministers did agree to consult on it now, it makes you wonder what they would be consulting on, since once again the deal has been done without any input from the public.

No wonder there’s such concern amongst people across Greater Manchester. The BBC visited my constituency in Wigan recently and reported public responses to the proposals ranged from bafflement to anger. With today’s deal over health and social care, that concern has been amplified.

Devolution can and should bring significant benefits to regions like mine. Decisions should be made closer to people, with greater local accountability, putting people and communities in the driving seat about choices that affect their lives. Real devolution – pushing power down to local areas, communities and families - gives us the chance to move away from a style of government based on ‘doing to’ rather than ‘doing with’ and draw on the talent we have in our region. It gives us the chance to pull together with charities, local businesses and community groups rather than commissioning services through big block contracts run by huge private companies.

But at best this deal, as George Osborne has constructed it, appears to transfer power from an unaccountable group of officials in Whitehall, to another group in Manchester town hall. With councillors across Greater Manchester lacking detail about their future role, the risk is it will level up power, taking decisions from a local to a regional level, where currently there is no direct accountability, and enable the centre to hold their hands up when problems arise and say “it is not my problem” - the exact words used by Nick Clegg in Parliament a few weeks ago when I asked why a deal that was supposed to empower the people had cut out them out altogether.

There are voices that argue that despite the lack of democratic accountability, public involvement or thought given to scrutiny and challenge, this is a step forward. They are right to point out that currently holding Whitehall to account is far too difficult. But surely we shouldn’t accept that there is only a binary choice between an unaccountable structure in London or another in Manchester. There is an alternative, as Andy Burnham has set out – a properly funded and locally accountable NHS that hands greater power to people and guarantees the public ethos at the core of the NHS. On that basis, devolution could be transformative for this country and its people.

But for now, democracy has become an afterthought. It’s time to put the people back into the picture, by strengthening local accountability, providing communities and councillors with the tools and resources they need to scrutinise and challenge those who hold power and ensuring no individual can hold such power without facing an election first. Instead of backroom deals about our public services, decided without us, behind closed doors, let’s build our public services with the best asset we have; the people.

Lisa Nandy is the MP for Wigan, and Shadow Secretary of State for Energy and Climate Change.

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Is anyone prepared to solve the NHS funding crisis?

As long as the political taboo on raising taxes endures, the service will be in financial peril. 

It has long been clear that the NHS is in financial ill-health. But today's figures, conveniently delayed until after the Conservative conference, are still stunningly bad. The service ran a deficit of £930m between April and June (greater than the £820m recorded for the whole of the 2014/15 financial year) and is on course for a shortfall of at least £2bn this year - its worst position for a generation. 

Though often described as having been shielded from austerity, owing to its ring-fenced budget, the NHS is enduring the toughest spending settlement in its history. Since 1950, health spending has grown at an average annual rate of 4 per cent, but over the last parliament it rose by just 0.5 per cent. An ageing population, rising treatment costs and the social care crisis all mean that the NHS has to run merely to stand still. The Tories have pledged to provide £10bn more for the service but this still leaves £20bn of efficiency savings required. 

Speculation is now turning to whether George Osborne will provide an emergency injection of funds in the Autumn Statement on 25 November. But the long-term question is whether anyone is prepared to offer a sustainable solution to the crisis. Health experts argue that only a rise in general taxation (income tax, VAT, national insurance), patient charges or a hypothecated "health tax" will secure the future of a universal, high-quality service. But the political taboo against increasing taxes on all but the richest means no politician has ventured into this territory. Shadow health secretary Heidi Alexander has today called for the government to "find money urgently to get through the coming winter months". But the bigger question is whether, under Jeremy Corbyn, Labour is prepared to go beyond sticking-plaster solutions. 

George Eaton is political editor of the New Statesman.