On Tuesday, George Osborne made the surprise announcement that health across London would be ‘devolved’. The deal will be piloted in Hackney, Barnet, Camden, Islington, Haringey, Enfield, Lewisham, Barking & Dagenham, Havering and Redbridge, but it is envisaged that the “devolution agreement” will then extend to cover the 33 London Boroughs and 32 Clinical Commissioning Groups covering the capital’s 8.6 million residents.
Observers of the previous biggest scheme – in Manchester – will recognise much of what’s on offer:
A new deal announced and clearly led by Chancellor George Osborne, with local government and health leaders playing a subordinate role.
Devolution – previously seen as a positive aspiration for local campaigners – had turned into something very different, imposed from the top downwards.
No prior public consultation - proposals rubber-stamped by Clinical Commissioning Group chairs and council leaders without reference to their boards or elected councillors, let alone any wider discussion.
No parliamentary debate. Tory legislation to extend devolution across England did not initially make any reference to the NHS. Section 18, which was added as an amendment, requires prior consultation: that clearly is being ignored in both big ‘devolutions’ so far.
Indeed the London announcement seems to have taken even NHS England boss Simon Stevens by surprise.
On Monday he told the Health Service Journal that he did not expect any rapid spread of devolution plans beyond the Manchester experiment. But then on Tuesday he was wheeled out in George Osborne’s press release to show his support for London’s even bigger plans.
As in Manchester, deals which start out as furtive, bureaucratic lash-ups are likely to remain so – with no democratic accountability, transparency or genuine devolution of power to local people.
In London we are offered only some sketchy detail of the initial pilot schemes.
But worryingly, the “devolution agreement” is conspicuously silent on controversial plans in North West London to close Ealing & Charing Cross Hospitals, with the devastating loss of over 600 beds, demolish most of the land and sell it off for flats.
Will that plan now be pushed through under the new powers? The closure of two smaller A&Es (Hammersmith and Central Middlesex) has already reduced local emergency services for the most serious cases at Northwick Park Hospital to some of the worst in the country.
As in Manchester, there’s no new money on the table to develop new services.
In fact London is supposed to find a further £4 billion of ‘efficiency savings’ by 2020, though almost all of its hospitals are already deep in the red.
It’s supposed to ‘free up’ cash by finding yet more ‘surplus’ hospitals and GP surgeries and arranging their ‘disposal’ for housing developments. One of the pilot London projects is to focus on just this, in the five boroughs of “North Central London”.
It’s obvious to anyone but a gullible or power-grabbing councillor, mayor or CCG chair that the government plan is to “devolve” responsibility and dump blame for massive debts and unpopular cuts and closures, onto those same dim-witted or ill-informed councillors.
Particular blame in each city must land on the Labour council leaders, who in each case are a clear majority of those declaring support (Labour leads 20 of London’s 33 boroughs, with the Tories currently leading only 9 in the run up to London elections in May 2016).
Tory Mayor Boris Johnson now has a key role in deciding on health services in London. Who thought that was a good idea?
Integration
One of a handful of specific plans is the setting up of an Accountable Care Organisation ‘integrating’ health and social care in Barking & Dagenham, Havering & Redbridge.
But the local NHS side is in no position to play its full role: the local Barking Havering & Redbridge hospitals trust is mired in massive debt as a result of a hugely expensive Private Finance Initiative contract for the £240m Queens Hospital in Romford, and seeking to make savings by closing the busy A&E at King George Hospital in Ilford.
Barking & Dagenham and Havering councils are also in a poor position to offer support – they are amongst the third of UK authorities who have joined the list of shame of those who have totally scrapped all “meals on wheels” services for elderly and vulnerable people.
Social care is on skid row. Care homes are nearly bankrupt. There are severe shortages of GPs, community and district nurses. Debt-ridden NHS trusts simply have no spare beds.
In this situation, 80% of areas expect to fail to deliver their targets for reducing emergency hospital admissions as part of the “Better Care Fund”. The cosy term “integration” ceases to have any useful significance - what’s the point of lashing together two broken and cash-starved organisations?
Add to this a blatantly undemocratic “devolution” plan, signed off by council leaders with a grim record of failing to stand up in defence of local services, there are real fears the “integration” of health and social care will mean the plundering of already inadequate NHS budgets to prop up local government services. Yesterday the Chair of the Local Government Association, Lord Porter, told BBC’s The Daily Politics that “we have to get our hands on the NHS funding”.
Social care has been plagued for decades by cuts, outsourcing and piecemeal privatisation of services, leaving many staff on zero hours contracts and service users with bewildering 15 minute sessions of ‘care’.
Now there is the danger that in some localities services could be “integrated” under local authority rules which levy means-tested charges for services, rather than the NHS principle of services funded from general taxation.
Simon Stevens stressed the need for “integration” in his Five Year Forward View but was at pains to give the impression that the NHS would remain in charge of its budgets. The new devo plans make clear that is not the case.
Campaigners see the risks now in plain sight – of more hospital sell-offs, and more services being privatised, withdrawn altogether, or charged for under the header of ‘integration’ - as Osborne pointedly fails not to adjust funding to meet the growing population and rising demand. This is not devolution, but dumping blame.
https://www.opendemocracy.net/ournhs/john-lister/london-devolution-its-obvious-to-all-but-gullible-power-grabbing-councillors-this
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