FROM Friday 1 April, the Greater Manchester authorities have taken over a £6 billion health and social care budget to serve a population of 2.6 million people as the government ‘devolve’ control of spending on health and social care to a new ‘partnership board’ comprising ten local authorities, 12 clinical commissioning groups, 15 NHS trusts and foundation trusts and NHS England.
The whole massive package was rushed through in a year with the enthusiastic support of the Labour-controlled local authorities who embraced the Tory claim that devolution represented the Holy Grail of ‘local accountability’ and democratic control freed from the shackles of Westminster.
The attachment of these Labourites to local democracy didn’t extend to any consultation with the people of Manchester who were denied any say in the matter – for the reason that there was huge opposition for what was rightly seen as a massive step towards breaking up the National Health Service.
Tory devolution marks a return to the 1930s, before the days of the NHS, when health provision was the responsibility of local authorities, a situation that led to the most appalling health inequalities across the country with no universal, comprehensive health care, free at the point of delivery, available to everyone wherever they lived.
Under this devolution of power and responsibility, universal healthcare will end. Devolution will introduce the very real prospect that local authorities like Manchester will no longer be bound to meet national standards. The NHS was established precisely to end this chaos and provide a universal free service and this is what the Tories are determined to smash.
Behind all the talk about the benefits of devolving power to local authorities is the simple reality that the Tories will hand Greater Manchester £6 billion and tell them to get on with it, absolving a Tory government from any responsibility for any future hospital or health service closures.
Greater Manchester authority is boasting that it will not just manage but improve NHS provision if only it gets its hands on the cash and responsibility for using it, although they have not spelt out how this will be achieved.
The answer is that they will fall back on the tried and tested strategy adopted by local authorities across the country of ‘outsourcing’ or, more correctly, privatisation. Already local authorities have devolved responsibility for some health care provision like care homes, almost all of which have been privatised as councils struggle to cope with the cuts in government funding. Currently those public health services already devolved are facing a £200 million budget cut.
Under the existing NHS system, if a health provider anywhere in the country gets into financial trouble, and most of them are, then rightly it is expected that central government will step in with funds to ensure that services don’t collapse.
Local governments, on the other hand, are bound by law to set balanced budgets meaning, they cannot borrow money to bail out any sector of the NHS that goes into deficit. This would leave privatisation or closure as the only option open to these authorities.
At a stroke, the Tories’ devolution plans, which they intend to roll-out from Manchester across the whole of England, means that they have placed total responsibility for implementing cuts in the NHS on these authorities while at the same time making them responsible for privatising the NHS out of existence.
Destroying the National Health Service as a truly national service and returning it to the pre-1948 days also opens the door wide open for breaking up national terms and conditions of health workers.
As the fight by junior doctors and the support they have from the working class has proven, workers are determined to fight for the NHS.
We call on thousands of workers and young people to join the lobby of the TUC general council meeting on April 27 to demand that they take action to defend the NHS by calling a general strike to kick out the Tories – this is the only way forward.