Since 2010, there had been consensus across all the major political parties that power in England should be devolved away from the centre, towards local communities. David Cameron, Prime Minister, announced in September 2014: ‘It is also important we have wider civic engagement about how to improve governance in our United Kingdom, including how to empower our great cities — and we will say more about this in the coming days.’
The first ‘devolution deal’ was signed between the Government and Greater Manchester Combined Authority in November 2014: The Greater Manchester Agreement. It outlined a range of policymaking powers that were devolved to Greater Manchester (GM), as well as strengthening of local governance.
In February 2015, the NHS and local government leaders signed Greater Manchester Health and Social Care Devolution Memorandum of Understanding, describing plans to combine health and social care budgets for Greater Manchester worth £6bn in 2015/16, which would involve the devolution of NHS functions.
The NHS Chief Executive Simon Stevens suggested that it had the 'potential to be the greatest act of devolution there has ever been in the history of the NHS'.
The devolution would incorporate the whole health and social care system in Greater Manchester including:
- acute care
- primary care (including management of GP contracts)
- community services
- mental health services
- social care
- public health
- health education
- research and development.
Under the new model, the Greater Manchester Combined Authority (GMCA), Greater Manchester clinical commissioning groups (CCGs) and acute trusts would be commissioned to develop a strategy for the integration of health and social care services. Greater Manchester NHS would remain within the NHS, and subject to the NHS Constitution and mandate, but commissioning for health and social care would be undertaken at a Greater Manchester level, rather than at a national level.
The Memorandum of Understanding (MOU) provided the framework for Devolution Manchester’s implementation.
NHS England suggested the devolution would help Greater Manchester focus on the prevention of ill health and assist in closing the health inequalities within Greater Manchester and between Greater Manchester and the rest of the UK. It committed to helping transfer skills and facilitating links to national bodies to support the handover of commissioning services to Greater Manchester.
In an early draft of the plans, it was suggested that Greater Manchester would be included in the vanguard of new care models introduced by the Five year forward view for the NHS in England. In the later version of the Memorandum this pledge was removed, but a commitment to be an implementer for delivering new models of care remained.
Responses to the devolution announcement varied. The Memorandum was signed by both the Chancellor of the Exchequer George Osborne and Secretary of State for Health, Jeremy Hunt, however Shadow Health Secretary Andy Burnham raised concerns that it could cause 'further break-up of the idea of the NHS'. The chair of the GMCA stated that the agreement had been incorrectly represented in the media as a 'town hall takeover of Greater Manchester's NHS budget'.
In May 2015, the Chancellor of the Exchequer, George Osborne, highlighted progress in developing plans for devolution in Greater Manchester, announcing it as 'a revolution' in the way England would be governed.
Osborne also confirmed that other cities would have the option to make their own devolution proposals and that the government would bring forward a bill to enable a radical new model of city government. The bill would enable Greater Manchester and other cities to take more control of services – from transport, housing and skills to health and social care. He added that, in return for greater powers, there would need to be city wide elected mayors.
In July 2015, a further MOU was signed to create a united, single leadership to place public health at the heart of Greater Manchester public service reform.
The MOU was signed by local authorities in Greater Manchester, Public Health England, NHS England and key partners including NHS commissioners and providers. It stated that key operational principles of a new, unified public health leadership system would include:
- a robust and evidence-based public health contribution to growth and reform priorities of Greater Manchester
- a relentless focus on wellbeing, prevention and targeted early intervention
- a recognition that citizens would be key agents in achieving better health outcomes
- a rebalancing of investment towards prevention
- a commitment that no decisions on public health leadership, investment or commissioning would be made without Greater Manchester.
The MoU set out five major transformational programmes and 12 early implementation priorities. The five programmes were:
- Public health, growth and reform and the spending review
- Social movement for health
- Starting well, early years
- Living well, work and health
- Ageing well
The 12 early implementation priorities ranged from developing an evidence-based case for the economics of prevention, to specific goals, such as reducing the impact of hypertension and improving the uptake of flu vaccination.
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