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The Tories' radical devolution plan is a massive challenge for Labour

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Is it possible, just possible, that the Conservative government may truly be radical when it comes to devolution to city and county regions?

Press coverage in the run-up to this week’s Budget certainly suggested that chancellor George Osborne might be willing to consider rather bigger changes to the structure of the state than would have been conceivable five or 10 years ago.

The chancellor is often described as ‘political’.

Some people see this as a failing, though in a democracy it is surely a good thing if politicians behave in a way that makes them distinctive from each other and where one party’s policies are different from the other’s.

For decades, the Conservatives and Labour have pursued a consensus policy of centralisation. Any differentiation between the major parties is to be welcomed.

It begins to look as if the Tories may have come to the conclusion that the NHS in its current form has, as far as they are concerned, reached the end of the road.

There has been wide media speculation that Cornwall will be offered control of a combined NHS and social care budget.

If Cornwall and Greater Manchester are to be given such powers, it would be hard to deny other areas, particularly London, equivalent budgetary freedom.

The seven districts of the West Midlands have finally formed a combined authority to bid for greater devolved power.

Supported by local MP and business secretary Sajid Javid, the new city region will be able to compete with its Northern Powerhouse cousins.

It is increasingly easy to see how ministers could soon take the remarkable step of fully devolving the NHS. 

For leaderless Labour, this process is a massive challenge.

The party is being left behind in the devolution debate while watching a threat to the national version of the NHS which most of its MPs see as the cornerstone of Labour’s history.

Moreover, Labour leaders in the cities and counties would willingly take control of the health service if Mr Osborne offered it to them.

This week’s Budget will tell us more about the chancellor’s willingness to change the public service landscape in Britain.

The need to shrink the State may have remarkable and unexpected consequences.      

Tony Travers, director, Greater London Group, London School of Economics

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