The devolution of £6bn of health and social care funding is the biggest show in town for Devo Manc for both its ambition and what’s at stake.
Central to the project is the integration of health with other public services to tackle issues such as long-term unemployment and links between mental health and crime.
Health and social care devolution is the biggest show in town
While budgets will continue to be controlled by the respective statutory bodies, the aim is for funding to be directed to where it is needed most.
A governance model has been agreed, although this is not legally binding.
Wigan MBC chief executive Donna Hall told LGC plans for devolution had so far been agreed on a consensus basis following leaders and officers “thrashing it out”.
Ann Barnes, chief executive of Stockport NHS Foundation Trust and the representative for NHS provider organisations in the devolution talks, said there was potential for devolution to improve health services.
“The spirit of Devo Manc has given us the catalyst to do things differently. It has spurred us into fundamentally thinking differently,” she said.
Greater Manchester is seeking to move away from a situation where providers compete to a collaborative approach that considers what is best for health and social care as a whole.
Ultimately, the ambition is that the NHS in Greater Manchester will move towards a per capita system of funding, away from the national tariff and payment by results system, under which acute hospitals are paid according to activity.
Despite the enthusiasm, several legal and political obstacles must be overcome before this ambition can be realised.
For starters, there is an inherent tension between the idea of the NHS as a national service and allowing one part of the country to adopt a distinct approach. Such tensions have attracted some political opposition to the idea.
Before parliament broke for summer, Labour Lords successfully moved an amendment to the Cities and Local Government Devolution Bill to prevent the transfer to local government of regulatory or supervisory functions from national NHS bodies.
While there is little concern about current quality standards in the NHS - Greater Manchester considers national standards to be the minimum - the amendment could hamper efforts to move away from the national payment regime.
In turn, this could harm Greater Manchester’s ability to make the savings it needs.
For the deal to be signed off, the combined authority must submit a ‘sustainability plan’ to the Treasury by the end of this year.
This plan is expected to detail how the GMCA will close the £2bn gap in health and social care budgets forecast for the end of the decade.
The combined authority is working with NHS England to draw up this plan and has already appealed for £500m of funding to put it into action.
The political capital invested in this deal by ministers should give Greater Manchester some sense of security that they will get the support they need. But its work on this major section of its devolution deal is only just beginning.