Devolution: What it means for health and social care in England

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Devolution of powers and funds from central to local government has emerged as one of this government’s flagship policies. Along with powers over housing, skills and transport, the 'Devo Manc' deal between the Treasury and Greater Manchester paves the way for the councils and NHS in Greater Manchester to take control of the region’s £6 billion health and social care budget.

Ahead of further devolution deals expected to be announced as part of the Spending Review 2015, this briefing describes the origins of the devolution agenda and charts its progress in relation to health and social care. Before drawing some broad conclusions, the penultimate section explores some of the key policy and implementation questions that remain unresolved.


malcolm heard

Comment date
04 May 2016
Devolution for health care in Greater Manchester might seem a dream, but over the passed years I have seen cuts backs in Rochdale, where I live reduced the town having two hospitals, now there is hardly any services at all, such as A&E, to me the health care is like trying to pour a pint of water into a half-pint glass, The government now in power have been known to take away money from funding many things, and if they cut the money to health care in Greater Manchester, will the government be to blame when there have to be more cuts

Pearl Baker

Independent Mental Health Advocate and Advisor/Carer,
Comment date
23 December 2015
Am I excited about Devolution for any City willing to 'have a go' not really, for the following reasons, we have yet to see how Manchester 'fares' first.

It would appear there is no 'blue print' on how it should be delivered in a 'uniform' manner, every City 'doing their own thing' would make it almost impossible for the CQC and 'MONITOR' to carry out their Inspections. 'Tick' boxes don't work. as we have seen recently with the terrible deaths in a Trust Hospital.

I would like to see the CQC report going directly to the Secretary of State for Health, and copy to those agencies they are responsible for Inspecting. The CQC must have a system in place to protect ALL those receiving health and social care from NEGLECT.

Discrimination is something not to be tolerated. ' making a distinction in favour of or against a person or thing based on the 'group' etc., this is why I campaign for the less able to speak for themselves. POSITIVE Discrimination is against the LAW, and the CQC must change their Monitoring of ALL those receiving Health and Social Care to be PROTECTED from a system of Abuse and NEGLECT.

I would have preferred to have seen 'delegated' powers to various groups, around 'integration' that must include housing and a 'single budget' based on the demography and actual recorded numbers of those in the system already, and those who have been DISCHARGED from 'Care Plans' while still being in the system. (Not recorded anywhere) unless you wish to 'delve' deeper into the Archives of Mental Health Trusts, you will then see thousands abandoned, often to the streets.

It would have been sensible to concentrate on 'Pooled Budgets; already have the ability to section 75 of the NHS Act 2006, which form the basis for the 'Better Care Form' which is used unequally amongst the most needy. The NDCCG were unwilling or unable to provide me with a statement of how much they received from the 'Better Care Fund' and a breakdown of what or who benefitted from it.

The success of Devolution is based on the calibre of expertise and willingness to implement 'fairness to all 'groups' based on actual data, collected from the Public, Complaints, CQC Reports based on a system of Non Discrimination.

I have some concerns with the actual Recent analysis shows that total spend on social care (for all age groups) is over 10% less in 2014/15?
I would really like to know where these figures came from, based on the FACT that LAs are reducing funds and cutting funding to vulnerable children, and mental health.

It is well known that LAs have different criteria for accessing their funds, this in itself makes a tremendous difference to your analysis. All LAs should have been contacted during your exercise to establish the criteria they are using?

My preferred choice is 'Delegated' powers in the first instance based around a 'pooled Budget' under section 75 of the NHS Act 2006.

The CQC will stop Discriminating and include an Inspection process 'fit for purpose' to protect all those receiving Health and Social Care.,this will actually mean the Inspection process of 'pooled budgets' complaints
currently considered outside of their 'remit' as unregulated. (discrimination).

Starting Point:
Delegated Powers: 'integration' under section 75 of the NHS Act 2006.

CQC to change their Constitution, or should I say implement when evidence concludes a Carers Input. 'Its services reflect the need and preferences of patients , their families, and carers who will be involved and consulted on all decisions about their care and treatment'

If the Carer satisfies the new criteria in the Care Act 2014 by providing evidence to that effect, then they should comply with the above CQC Constitution.

'Integration' means exactly that, the LA must also be Inspected on their involvement in the process 'integration' of 'polled budgets'

'Integration' Holistic call it what you like, currently there is a BIG 'divide' in the delivering of Health and Social Care outside of the Current Regulatory CQC process.

To put in place Devolution by only knowing half the story is NOT Progress, to build on what you know is Discrimination for the many thousands outside of the current CQC and 'MONITORS' regulatory Inspection would be PROGRESS.

I have worked in Mental Health for Thirty years. I know how the system operates, and support those severely mentally ill abandoned, often to the streets, Look Listen and Learn!


Comment date
17 November 2015
Can we take devolution a step further and devolve the NHS to itself?
We can build from the ground up a new mechanism for the NHS to take direction from, and be accountable direct to the public without ideological interference from the government.
Parliament has demonstrated that it cannot be trusted with the NHS. Politicians are idealists, the NHS needs to be run by realists.
We need to establish a

Margaret Hughes

Lay representative/Volunteer,
Comment date
16 November 2015
I concur with everything that Umesh Prabhu has to say on the subject of Devolution in Gtr. Manchester. One point to emphasis is the importance of Patient Involvement. At present the man in the street is not even in the loop. I assume patients are involved somewhere but who are they? How have they been selected? What is their role? and to whom are they accountable? Without real and transparent Patient and public involvement this will not work and it is too important to fail.

Umesh Prabhu

Wrightington Wigan and Leigh FT
Comment date
14 November 2015
I am really excited with the idea of Devolution and in Manchester it gives fantastic opportunity to transform health and social care and gives an amazing opportunity to make NHS safest, best and much more efficient and economical and money released can be invested in many areas like Dementia, Mental Health, community care, palliative care, diabetes and so on.

However it all depends on having right leaders appointed for their values, leadership skills and not simply for their technical skills. We need both senior leaders, clinical leaders, Non-Executive Directors and Council leaders all appointed for their values as well as for their technical skills. There must be clear accountability and governance for all leaders and managers who have been given the task to deliver. There must be robust staff and patient engagement and everyone must make sure patient safety, quality is at the heart of any decision.

If we don't get leadership right and if it is same old leaders doing same old things then Devomanc can be a disaster. As Anthony Robinson said 'It you always do what you have always done then you always get what you always got.

In many ways NHS is the easiest organisation to lead and manage as it has many amazing staff with very high values and most of them always do what is right for their patients. NHS simply needs good leaders appointed for their values and are held to account for their own behaviours and values. Leaders who are kind, caring, compassionate but also have courage.

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