1. Governance
March 2, 2015updated 30 Jul 2021 2:45pm

Giving Manchester control of its health budgets will improve the NHS

By Luke Raikes

George Osborne’s plans mark yet another leap forward for devolution within England. Greater Manchester is set to be handed control of its £6bn health budget – following the previous agreement to devolve powers over housing, skills and transport in return for a directly elected Mayor to jointly govern the city-region. In a country as centralised as ours, this is an opportunity not just for better policy-making, but for more democratic city governance.

We’ve grown accustomed in this country to being governed from the distant centre and the disappointment which often results. We’re amongst the most centralised of developed countries, and polling has shown that 59 per cent of people think that decisions on public services would be better made locally, while only 14 per cent think they’re better made nationally.

But the citizens of Greater Manchester will soon see some of the decisions which are currently made by distant ministers and barely accountable government agencies made instead by a more conspicuous figure: the Greater Manchester Mayor, directly accountable to the city-region’s 2.7m people.

People might immediately draw a comparison with the Mayor of London, but Greater Manchester’s governance will be different and better. The powers are significantly greater and – by design – policy-making will be integrated and coordinated with the constituent authorities, instead of floating unanchored above them. The ‘Manchester model’ of city governance makes it possible to devolve and integrate health spending in a way that could not be achieved in London with its current structures. This new Mayor – together with the ten local authority leaders – will be charged with accelerating the city’s recent economic and social resurgence.

The way we are governed is clearly important for good policy-making. A wide-ranging OECD report published last week added to a substantial body of evidence which shows how good city governance is a critical factor in their growth and well-being.  

But beyond arguments about effective governance, integrating services and driving economic growth, there are clear democratic reasons to support the prospect of more accountability in politics.

The new model of governance will inject a significant shot of democratic accountability into the politics of the city. This is positive for various reasons: putting more democratic power in the hands of citizens is clearly a good thing in its own right; it will also ensure that a diverse and vibrant city isn’t ruled by strangers in Westminster, or by an indirectly elected committee within the city-region; and it will of course be an extra incentive for services to be delivered well and with no excuses.

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Under this new system, robust checks and balances do need to be put in place to ensure responsiveness is maintained in-between elections too. The ever-growing scope of this mayor’s role means that transparency and scrutiny must be assured, and that the democratic will of one of the most diverse populations in the UK isn’t crudely packed into a single figure. 

There has been something of a campaign for a referendum on these developments, and some are understandably unhappy that this has come out of the blue, and been imposed from above. However, given that this agreement is itself far more democratic and accountable than the status quo, this concern appears to be somewhat misplaced.

Some may also be concerned that the devolution of health in particular somehow fragments the NHS. However, the NHS is already devolved to other parts of the UK without compromising its core principles, and only by devolving some power over the NHS can the aims of integrated health and social care be truly achieved. Nobody is arguing that social care should be centralised.

Greater Manchester may be first, but should not be alone, and this isn’t the only model for other places to adopt. While power needs to be devolved across all of England, there are solutions that may work better elsewhere. 

But it is time to undertake significant, structural democratic reform, and inject real transparency and accountability. The Mayor may have been presented as a condition for greater devolution, or an imposition from central government in order to gain more devolved powers. But it isn’t a necessary evil – far from it. This is an opportunity for democratic and political renewal in our cities; it’s an opportunity citizens need to embrace.

Luke Raikes is a Research Fellow at IPPR North. He tweets @lukeraikes.

This article was originally posted on our sister site, the Staggers.

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