On Monday, Andy Burnham, our Prime Minister in waiting, set out his vision for the country.
At the heart of it is a devolution revolution – a massive shift of power away from Westminster and Whitehall towards local communities. It’s exactly the kind of bold reform we need to overcome decades of decline.
I still work as a GP, as well as MP for Stroud, and on the train back down from Manchester I got to thinking about what Manchesterism could mean for our health service.
The three mantras of the NHS: cure to prevention, hospital to community, and analogue to digital are all laudable, but delivery is more difficult than rhetoric.
And delivery demands one thing above all: real devolution of power, budgets and control.
Neighbourhood health centres offer a way to deliver those changes but there are dangers. Today I read that hospitals are making bids to run GP surgeries. This would be a disaster. We must shift funding towards community care, but the reality is that this is not happening.
So, what can we do?
In Stroud, I led a place-based NHS, that was centred around patients over just hospitals. On our board was a plethora of people and organisations.
GPs, district nurses, health visitors, mental health workers and social care, physios, hospital consultants, paramedics, dentists and, yes, patients themselves, were all sat around the same table. But on top of that we had food producers, housing specialist, park managers, DWP staffers, artists, educators, religious leaders and social enterprises.
What we achieved was remarkable. In Stroud, there is a now a network of nine community hubs based in the most deprived areas of the district. They work with foodbanks, GP surgeries, mental health support workers and welfare advisers. We’re putting care exactly where patients need it: at the heart of community.
Last week, I spoke to an MP who said she didn’t really have an idea about what “community meant”. To be honest, it can be thrown around as a nebulous word – a good thing but hard to define.
What I realised is that community is a set of relationships. It’s over coffee after the meetings in Stroud where plans were hatched and real change happened.
The issue is that the people delivering care are split across multiple employers. GPs, community nurses, mental health services, social care and hospitals all operate in silos. That makes true integration almost impossible.
We need unified, devolved budgets at a local level, giving communities the power to design services around people.
The gains would be sizeable. When mental health professionals work directly out of GP surgeries, productivity can triple. Patients are seen earlier, faster and more holistically.
Social care must follow the same logic. The current model, shaped by the legacy of Thatcher, is inefficient and absurd. Carers travel miles while the frail neighbour living next door receive visits from entirely different agencies.
It makes no sense. Care should be organised locally, delivered locally, and rooted in the communities it serves. In the long term, that means moving towards a National Care Service.
We also need to rethink access. Local health centres and minor injury units could provide care late into the evening if we shift resources away from hospitals and into neighbourhoods. Keep A&E for true emergencies but treat people closer to home wherever possible.
And crucially, we must abandon the idea that one size fits all. Different places have different needs. Devolution allows flexibility while maintaining national standards. Everyone should have access to high-quality care locally, but how that care is delivered should reflect the community it serves.
That is the promise of Manchesterism for the NHS. A system where power sits locally. Where prevention is prioritised. Where care is built around relationships and where patients receive high-quality treatment close to home.
Without that shift, nothing really changes. Hospitals will continue to absorb the lion’s share of funding, A&E waits will grow, and outcomes will stagnate.
But with it, we have a chance to build an NHS that is truly rooted in the communities it exists to serve.
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