Anna Athow, retired surgeon
Greater Manchester Association of Trades Union Councils ( GMATUC ) called a mass NHS emergency protest rally to protest against the devolution of the Greater Manchester NHS Budget, called “Devo Manc”, without public scrutiny.
An emergency resolution passed by GMATUC stated in part, “ As trade unionists we can only suspect that the break up, dismemberment, rationalisation and further privatisation of the NHS in England ( under the banner of public service reform) is precisely what it’s all about, and being hurriedly imposed to avoid any such thorough examination, scrutiny and proper public debate of the issue.”
The motion ends by calling for a referendum on ALL the Greater Manchester devolution issues.
On 27th February 2015 Chancellor George Osborne, and the chief executive of NHS England Simon Stevens held a press conference to announce a “Memorandum of Understanding” for “Devolution of health and social care in Greater Manchester” ( GM ).
This marked a deal to parachute in a £6bn pooled health and social care budget, direct from the Treasury to a new GM Strategic Health and Social Care Partnership Board – in shadow form from April 2015, and statutory by April 2016.
This board contains leaders of 10 Local Authorities ( LAs ) ( 12 Clinical Commissioning Groups ( CCGs) and representatives of NHS England ( NHSE ), as well as providers and voluntary organisations.
The Combined authority of GM consists of LAs ;Bolton, Bury, Manchester, Oldham, Rochdale, Tameside, Salford, Stockport, Trafford, Wigan,- an area of 5000 sq miles, and 2.7m population.
This deal came as a complete surprise to everyone but a few top council leaders, such as Sir Howard Bernstein and Sir Richard Leese, who had secret negotiations with Osborne for six months and then persuaded the 10 LA leaders ( 8 Labour ) to agree. Members of the public, NHS staff, trade unions, and Members of Parliament, had no idea.
The deal dictates a massive change in the way that commissioning and funding of healthcare is organised in GM, changing the deckchairs again, beyond the Health and Social Care Act 2012.
The purpose of it, is to drive through the Healthier Together programme to close 4-5 acute District General hospitals ( DGHs ) in GM , and divert the funding into the new business “models of care” outlined in Simon Stevens’ “ Five Year Forward View”. ( FYFV)
The budget for health and social care is to be pooled. The commissioning for health and social care is to merged together into Joint Commissioning Boards ( JCBs )of local councils and CCGs.
There will be four tiers of new management. The Strategic Partnership board will be supervising a JCB for GM, standing over localised JCBs.
At the very top will be a Programme Board including Simon Stevens, John Rouse from the Department of health, leading local figures in the Healthier Together programme, and Graham Urwin from Staffordshire and Shropshire.
(Staffordshire is the area where contentious reconfigurations have just taken place with the removal of A&E, paediatrics and maternity from Mid Staffs hospital and a £700m, 10 year, privatisation deal for Staffordshire’s Cancer services.).
NHS England has representatives on every one of these boards. So despite the appearance of local decision making, NHSE will enforce its own policies.
These huge administrative changes will make possible the bringing together of funding streams from NHSE, the CCGs, the LAs, Public Health England, mental health and social care all into ONE POT.
The Joint commissioning boards will then be able to re- direct this funding, away from our District General Hospitals and GP surgeries and tertiary care, into the “ new models of care” outlined in the FYFV.
The Memorandum states “GM is to be” a trailblazer for the objectives set out in the NHS Five Year Forward View”.
The main objectives of the FYFV presented by Stevens in October 2014 are to impose A – “ new models of care” modelled on the US healthcare system.
B. –a new “ modern workforce” fit for these new care models. i.e. a workforce with local pay, 24/7 working, flexible and able to ‘cross boundaries’, highly efficient with increased productivity and reduced skill mix, with changed terms and conditions, altered training, and with a huge new role for volunteers.
The ‘ new models of care” include 1.large out- of- hospital providers; “Multispecialty community providers ( MCPs )” and “Primary and Acute Care systems ( PACs )” , 2. “Small viable hospitals” ( which would be dumbed down DGHs without proper A&E s), 3. “Specialised care” such as cancer and elective orthopaedics on networks with prime contractors. 4. ‘Networks of emergency and acute care’, with a halving of the number of Type 1 A&Es.
Steven’s key drive is to get the MCPs and the PACs off the ground in his so called “ Vanguarda” of “ integrated health and social care”. GPs surgeries are being coerced through underfunding to federate up into these MCPs, which are designed for populations of 50,000 to 300,000. and could even take over a downgraded local hospital.
(These would contain medical and nursing staff, social workers, care assistants ‘new roles’ and lots of management. The idea is that these would provide primary care, and elements of elective hospital work, mental health, public health, and out of hoursemergency calls.
They would tender for a new contract and could be prime contractors doing commissioning and providing, and could sub-contract out pathways of care. Patients would be registered with a GP and the work would be done on a capitated budget, which could not be overspent.)
MCPs and PACs are modelled on American health maintenance organisations such as Kaiser Permanente. They make a profit by incentivising staff to limit hospital referrals and care.
It is for these, that the health budget has been merged with the social care budget, as they will be providing both health and social care.
And of course, putting the provision of health and social care in the same contract, makes it easier to start charging for healthcare in the same way as for social care. Patient charges are clearly on the agenda of an incoming Tory government.
The propaganda slogans of “ joined up care” and “ integrated care” of the Vanguards, are a clever disguise for prime contracting and subcontracting i.e. disintegration and outsourcing.
These objectives have nothing to do with improving patient care, but of opening the way for takeover of NHS clinical services by multinationals, to make a handsome profits.
Already, we see our NHS in crisis with a severe lack of beds and staff.
Unions and campaigners and the public must oppose this plan from the start.
Devo Manc is part of much bigger devolution plan with pretensions to devolve £22bn of public funding to the GM Combined Authority, – to commission policing, planning, housing, transport , training,etc.
It is a poisoned chalice. The responsibility for making the billions more of public spending cuts will then rest with the devolved authority, and a mayor, whichever government gets in at the election.
The Devo Manc plan is a blitzkrieg attack to fast- track the reconfiguration of the NHS into new business models ready for private company take over.
It is a declaration of war on the health unions and the workforce, as it depends on ending Agenda for Change and doctors current contracts, and pushing through local pay and 24/7 working. They want a drastic reduction in jobs and more unskilled workers and volunteers, to hike up “ efficiency” and cost cutting, so that the circling private companies can make massive profits out of public sector contracts.
They want the end of a national public sector workforce with high levels of training.
The devolution deal is designed to use local councils and NHS leaders to break up the NHS area by area, using new commissioning structures and methods of funding, all dictated from the top. It is localised dictatorship. The aim is to end the NHS as a national publicly provided service. Then use it as a “test bed” and “ trailblaze” similar deals all over the country.
Above all there must be a huge struggle to defend what we have ; all our DGHs, our GP surgeries, our ambulance services, our community services, public health, and whats left of mental healthcare. And our public sector workforce.
The same devastation is being wreaked on all the public services. United action by the unions is needed to bring back these services into public ownership.
Labour is committed to the same policies and welcomes the FYFV and Devo Manc
Defend our District General hospitals and GP surgeries.
No to the new business models of care. No to the new cheap labour workforce
Down with the Five Year Forward View.
Defend the NHS as nationally publicly funded and provided service.
Down with Devo/ Manc. It must go