We all know that the top down reorganisation of the NHS has been a money wasting vanity exercise. We all however agree that it is the N in the NHS that is important – wherever someone lives they will be entitled to the same standards of care. We know that in health post code lotteries already exist, as they do in social care but if the greater Manchester leaders believe that by accepting a snap off ‘RHS’ a ‘regional health service’ they will somehow be able to wave a magic wand and end health inequalities they are living on another planet.
First of all in the absence of detail where are the guarantees that the funding will remain or grow at current levels in line with NHS spending in other areas of the country? We already have a crisis in social care spending but not a penny more is being put on the table to tackle that funding gap and whilst in the longer term integration of health and social care will, it is hoped save money, the evidence is certainly not there about how much can be saved, and, whether these savings will be enough to meet the exponential growth in demand. And of course the Greater Manchester authorities will inherit the funding crisis that is already hitting the NHS in the sub-regional area, nicely excusing the Tory administration of any blame – look what has recently happened to Wales.
Of course there is a convincing argument that reform has to start somewhere so why not now? The answer is very simple the NHS has to remain as a National body, with a reformed centre and reformed funding structure with regional accountability and direction but not become a regionalised service of itself. Health spending and commissioning needs to be scrutinised and that should sit at a local level. The NHS has to be answerable to local areas – and why not through local councillors or scrutiny boards? The false barriers between health and social care, both in terms of bureaucracy and funding, need to be smashed down. But not in this way!
The speed of the planned route map to NHS devolution is alarming. Can we really expect change on this scale within what will effectively be a 12 month timescale? Instead we will create a monstrous circus of management consultants to feed the beast of yet another layer of management within the NHS and local authorities, at a time when much needed managers and operational staff are being lost from other frontline council and NHS services. Moreover we will see from April 2016 new commissioning boards that could decide on privatisation of large swathes of the NHS services, or adopting bargain basement contracts with new providers, with no social or ethical considerations taken into account. This is already an issue with the haste to bring in a new Statutory Instrument this week on social care and health which ignores employment considerations from public service contracts. Yes these new commissioning boards will operate outside of any electoral accountability – tied into a promise of a vote on a future Elected Mayor for Greater Manchester but in the meantime democracy lays slain at the altar of supposed devolution.
And of course the real question for UNISON is ‘what about the workers’. Reorganisation on this scale will impact on collective bargaining – who will be the employers of this new group of shared workers? What about their pensions? The terms and conditions of workers working side by side with no consultation? Where has been the trade union consultation on TUPE or other staff transfer implications. It is not good enough for trade unions to be thrown a kipper sometime in the future – workers needed to be at the heart of these proposals from the start.
So there are some golden opportunities to improve health and social care services; there is a need for great reform and funding of social care, mental health and some cancer services is already at a critical point. Just doing the same thing over and over again is a madness which keeps on resulting in the same points of crises so yes we do need reform; But this is a poison chalice filled to the brim with under-funding, the vanity of local leaders and political manoeuvring by the Tories in the run-up to an election. It would be a foolish person indeed that drinks from this particular cup.
Anna Rose