In a few months time, Greater Manchester will make history by choosing its first ever directly-elected regional mayor. Devolution is necessary, long overdue, and cannot be allowed to fail. The pressures in the NHS cannot be solved from Whitehall or Westminster. They can only be solved by people closest to these problems taking charge of their own lives.
Handing powers over transport, homes, policing, skills and the NHS to an elected mayor could profoundly reshape our public services for good, putting people and communities in the driving seat when it comes to choices that affect their lives, not just in Greater Manchester, but across the country.
Greater Manchester is an ideal testing ground to pioneer these radical reforms, in part because of the good working relationships between local leaders, built over decades. But the challenges for health devolution are great. Greater Manchester is a diverse area, facing varied and complex health challenges, from my borough in Wigan with a legacy of chronic ill health from the mining industry, to the challenges of a younger, urban, diverse population in central Manchester.
A&Es are under unsustainable pressure from cuts to social care. Cancer diagnosis is exceptionally poor. There is a desperate lack of support, both financially and structurally, for mental health. And under the terms of the devolution deal, there is a £2bn funding gap. It will take every bit of energy and creativity to solve this, and it must start with the best asset we have – people.
Today, a new report from the Fabian Society has found that although there is significant support for local leadership in the NHS, more must be done. Too many people do not know what devolution means. They want more information and transparency, especially where devolution is already underway, and protection from postcode lotteries.
More than two years after the health devolution deal was announced in Whitehall and signed behind closed doors in Manchester town hall, the people remain largely shut out of the conversation. The public consultation on these sweeping changes was not properly publicised, ran for just three weeks and received only 12 responses – 10 of them from the same council leaders that signed the deal in the first place. It didn’t even mention the NHS.
There needs to be a cultural shift in the way this process has operated so far. These major health reforms, the most radical and risky to be proposed since the NHS was founded in 1948, have been subject to just one public consultation that ran online and through 10 public meetings across the whole of Greater Manchester. The vast majority of the public are unaware that the consultation “Taking Charge Together” ever happened, only 6,000 people in a population of 2.8m have responded.
Resources should be made available to local communities to get involved in this process and help to shape it. Documents must be cleared of jargon and written in a language that most people can understand. Challenges to the system must be welcomed and embraced, and formalised through a forum that publicly holds the mayor to account. Just as select committees are properly resourced and supported, councillors should be given the skills, time, resources and independence to scrutinise decision making and highlight where decisions are failing us.
In the wake of Brexit, where communities in towns and villages across the country demanded the right to be heard, to ignore this desire for greater power would not just be wrong, but politically catastrophic. Those areas must be given a voice, and more importantly, the ability to hold the Mayor to account. Great Manchester is dominated by Labour representation, but it is essential in a healthy democracy that an individual as powerful as the mayor is scrutinised on a cross-party basis, both to ensure challenge and to give a voice to people across the region who hold different views. Civil society has not been involved or consulted. And so far, there are no plans to change this.
A model that does not have the will and support of the people will not succeed. The UK is inevitably and rightly shifting towards a federal model and getting this process right is critical. That can only mean a mayor who is accountable to and directed by the needs and lived experiences of the people they represent. Real devolution comes from public consent. Democracy cannot be an afterthought.
The Fabian Society report Local and National: how the public want the NHS to be both is published on Thursday.