01.07.15
NHS devolution to Greater Manchester ‘a bureaucratic mess’
The deal devolving NHS powers to Greater Manchester is in danger of becoming “a bureaucratic mess”, the House of Lords heard.
The Lords discussion on the Cities and Local Government Devolution Bill saw government minister Baroness Williams struggling under an onslaught of governance questions from the Labour benches.
NHE previously reported that it emerged in Lords debates last week that the health secretary would have the power to overrule decisions made by authorities in Greater Manchester under their devolved health and social care powers.
Labour peer Lord Warner described such an arrangement as “an Exocet under some of the principles in the Bill”, and returned to the issue during the debate held on Monday.
“What we do have is the minister’s expressed view, which causes me the greatest concern, that the Health Secretary could overturn local agreements if he thought them wrong – or ‘bad’, in her words,” Lord Warner said.
“In other words, agreements hammered out locally could be overturned by a minister in Whitehall because he did not like the look of them or he had been got at by an adversely affected particular interest. I can assure the minister, having been a health minister who sat in Whitehall and dealt with hospital closures and changes, that there is no shortage of people coming forward to tell you it is a thoroughly bad idea.”
Baroness Williams stood by her position, saying: “It is important that the secretary of state, of whichever department, can intervene in any matter which he feels is to the detriment of the public.”
The Lords continued to press on the issue with Lord Hunt and Lord Warner raising several points for the minister to address, including the extent to which the Greater Manchester Combined Authority would take health decisions and exactly what areas the deal covered, including the cancer drugs fund.
Baroness Williams said there was no need for specifics to be included in the legislation as it was already covered in the Memorandum of Understanding between Greater Manchester and the government, signed earlier this year.
The MoU details how decisions would be taken by a 'partnership' of councils and local NHS bodies.
Lord Hunt asked in response: “Who do I sue then? Who is accountable in this great mushy edifice that has been created? Who is the accountable officer? That is what we are trying to get to – who can you point the finger at and say, ‘You are responsible ultimately for what happens in Greater Manchester’s health system’? That does not seem to be coming through at all in this.”
Baroness Williams was very uncertain in her answer, pointing to the partnership board and its chairman, but she could not say whether it was a statutory body which would be accountable for the decisions made in the area.
Speaking after the debate, Lord Hunt told the Manchester Evening News: “The minister seems absolutely clueless about how the devolution settlement is going to work for the NHS in Manchester.
“It’s completely unclear which NHS responsibilities are being devolved to the Greater Manchester combined authority. It’s also completely unclear which body is ultimately accountable for the NHS in Greater Manchester.
"The risk is that far from being a bold move to decentralise decisions, a bureaucratic mess is being created.”
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