Emma was invited to speak at a fringe event about Devolution and the implications for Health and Social Care integration in the Combined Authorities’ model.
Whilst Labour believe in the principles of Devolution and the benefits of properly joining up services that naturally overlap like health and social care, there are very real concerns about how this is being achieved. The crisis in adult social care following vicious government cuts is only set to get worse and there is deep unease about the speed of the changes at a time when the NHS is still reeling from an unprecedented overhaul.
The devolution deals offer no detail at all about the mechanics of how the integrated services will work and lots of questions remain unanswered, not least how the ‘National’ Health Service can remain national if there are different regional deals.
You can read Emma’s speech below;
Thank you David for inviting me to speak and thank you all for coming.
Labour believes in Devolution. Giving regions more powers to control services in their communities is a good thing – the Devolution Deals, though far from perfect, are a positive step in giving areas the range of powers they need to create jobs, build homes, strengthen communities and protect the vulnerable.
The deals have been controversial and whilst we are right behind our councils who have worked hard to get the best deal they can for their areas, the Government has bullied its way through a succession of back-room deals in what has been a shameful, opaque and undemocratic process. It is no coincidence that the Labour regions who bore the brunt of the government cuts have been the first to accept the Government’s take it or leave it offer.
We only have to look the difference between the £2,700 per head spent on transport in London compared to the paltry £5.00 per head in the North or their shameless behaviour in offering transitional funding to local government in wealthy, Tory Southern shires, to know that the Chancellor’s concept of the Northern Powerhouse is – in reality – empty rhetoric. Quite frankly, I believe the Conservative’s master plan of a Northern Powerhouse is simply nothing but a joke.Only recently we have seen North East Tory MP, Guy Opperman, hold a Northern Powerhouse fundraiser for his own party in an exclusive part of London while at the same time North East Labour MPs were holding the Tories to account about cuts in our region. We also had the Northern Powerhouse Minister, James Wharton, absent from two debates about the North East and as Jeremy said just this morning 97% of Northern Powerhouse staff are London based.
So this is what the Conservative’s Party’s version of devolution is all about. Style over substance and Opportunism over accountability.
Councils were rushed into signing up to deals without the time for transparent scrutiny and without the time to consult the public properly.
The whole point of devolution is to bring power and decision making closer to the people – to make local government more accountable. This can only be achieved through a thoroughly democratic process. We must work together to ensure we get the deal we want not the one they want!
In terms of Health and Social Care, messages coming from Manchester who are further down the road on this process, indicate that we need to show caution. Under this Government we have a crisis in adult social care and our NHS, local authorities are predicting a 4.3 billion pound gap in adult social care by 2019-2020 and in 2013 NHS England and the Nuffield Trust estimated the NHS funding gap by 2021 could have grown to 30 billion per year.
In April the Greater Manchester Partnership will take control of a £6 billion health and social care budget for the region.
The 10 councils, 12 clinical commissioning groups, 15 NHS providers and NHS England will take responsibility for adult, primary and social care services. The region will also control mental health and community services and public health.
Whilst it is common sense to bring together connected services such as health and Social Care. This should not be rushed by a Tory timetable.
Tension is building between local and national arrangements and there is a clear and growing concern about whether the ‘national’ in the NHS will be preserved or what will happen to cross regional services.
It is not devolution but delegation, delegation of cuts and delegation of services that have been decimated by this Government.
Instead of formally transferring powers and accountabilities from NHS bodies to local authorities, NHS functions and resources are ‘delegated’ to combined authorities or joint commissioning boards who will be making decisions about professions they know very little about and add yet another level of bureaucracy in an already complicated system, with little scope for the voices of those who actually use the services.
And whilst we all know the devil is in the detail, the Government has left arrangements very vague.
Analysis by The Kings Fund and others have found that questions about the way this new governance model will work in practice remain unanswered.
How for instance, will accountability and regulatory oversight work in devolved areas? If NHS England remains accountable, which is what we are being told will be the case, then will combined authorities need to seek `permission’ to make major changes and, will NHS England be able to veto arrangements it does not like?
Although the intention of central government has been to encourage areas to think radically and creatively, the lack of transparent criteria has resulted in areas being uncertain about what is expected of them.
The financial frameworks and cultures of the NHS and local government are very different, creating the potential for confusion surrounding what a devolved body is allowed to do – and what it is not.
We understand that integrating budgets is a key part to connecting health and social care services but again where is the detail? We want to see protections put in place for instances where there are disputes about how pooled cash is shared, what happens to overspends or underspends, or where there are other governance issues.
It is hardly surprising that there are already divisions between different services and different authorities who, quite naturally, have vastly different opinions about how the money should be spent. There is a legitimate anxiety from social care professionals over how their profession can remain distinctive when integrated with Health. Similarly, Local Authorities on the outskirts of cities fear the lion’s share of the budget going to the City and rather than being given power, they will actually have local power taken away.
And how will anyone know if NHS devolution has actually led to improvements or not. During the passage of the Cities and Devolution Bill, Labour raised all of these legitimate concerns, but our proposals were typically ignored.
Finally, what is the core objective of devolution in relation to health and social care? Is it reducing health inequalities, delivering locally tailored, integrated care and improving population health? Or is it a way of achieving savings and reducing spending in the future? Or is it a way for the Government to put the blame on local areas for chronic underfunding and problems in the health and social care sector, absolving themselves of blame for the situation they have created?
Given the huge pressures facing the NHS and local government, it is essential that devolution is taken forward in a way that actually delivers for communities. We have a wealth of talent and ability in the North East so this shouldn’t be impossible for us.
Integration and devolution of health and social care is a great opportunity for us to properly shape our health and social care services for the future. In the North East deal, the commission for health and social care integration has quietly begun its work and is due to report on the possibilities for health and social care integration this summer. So far, the Tees Valley deal doesn’t include health and social care integration.
But friends we need to ensure our voices and the voices of our communities are heard and are part of this. I, like many of you, have a vested interest – I use local health services, my family use local health services and we are going to grow old here. I like all of you want the very best for all of our futures and I will not rest until we get it