Tag Archives: Greater Manchester

Devolving health and social care in England: an opportunity to transform how we approach health and care?

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In recent years, the Department of Health and Social Care (DHSC) has increasingly encouraged the transfer of powers over health and social care in England away from central government and towards city regions. These bodies, DHSC argues, are uniquely placed to understand the challenges faced by their local populations, the capacities and expertise of their local NHS and to develop plans for the future. This should enable them to approach health at a local level, promoting increased delivery of care in the community, and a greater integration between health and care services.

Putting local places at the centre of “Build back better”

In August 2020 the Health Devolution Commission launched its final report, Building back health and prosperity. Among other themes, like taking a “health in all policies approach”, the report found that devolving accountability and power to a more local level creates the potential to understand communities and places better, and to meet their needs.

The NHS Long Term Plan has also outlined a new direction for the NHS based on the principle of collaboration rather than competition, and the introduction of new structures such as Integrated Care Systems, Integrated Care Providers and Primary Care Networks. These partnerships bring health and social care commissioners together to plan and deliver integrated and person-centred care.

In the context of “building back better”, awareness of how our external experiences and contexts impact our health and wellbeing (for example the impact of poverty, deprivation, housing, and unemployment) is increasingly important.

Beyond the immediate recovery from the pandemic, health devolution could be one way of opening up the possibility of integrating not just disparate services within the NHS – or even NHS and social care services in a locality – but bringing together in a combined strategy and structure all of the services, systems and partners in a community that have an impact upon the health of a local population, and the care services to better meet their health needs.

“It doesn’t have to be a battle”- partnerships and balance are the key to effective devolution

The move away from centralised processes and organisations towards more local ones can sometimes be portrayed as a rejection or an attempt to “break free” from central government. However, practitioners have been increasingly stressing that devolution does not mean complete independence, and that while improved local decision making will improve outcomes for local people, that does not mean that the need for some centralised decision making is completely removed.

On the contrary, some decisions should and will be taken at a national level, but the ability to distribute power, decision making and accountability to a local level will have significant positive impacts for improving “citizen voice”, transparency and co-production in decision making.

This is where the Health Devolution Commission argues that balance, communication, and partnership between the local and national infrastructure needs to be aligned so that devolution can be successful and sustainable. Integrated planning and management of long-term health care strategies is important, as is the ability to bring citizens and local decision makers into discussions about national health policy.

The Voluntary, Community and Social Enterprise (VCSE) sector, including patient voice and carers organisations, also plays an important role in linking together services and communities. As well as partnering to deliver services, these organisations also often offer vital bridges between statutory systems and those communities which can often be excluded from engagement with services or who can find it harder to access them. The commission also emphasised the importance of bringing these bodies into the conversation on devolution going forwards as they will be invaluable partners in the process.

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DevoManc providing the blueprint?

In 2016, as part of a pilot, control of the health and social care budget for Greater Manchester was transferred to a partnership team in the area comprising local authorities, clinical commissioning groups, NHS foundation trusts and NHS England.

The combined authority identified that the health of its population was one of the key obstacles to its economic growth. By relating the concept of regional economic prosperity with health, they began to see health in a completely different way – as part of a wider plan and an investment for growth, not a burden.

“It’s better to have decisions made locally, because local people understand what local problems are and what Greater Manchester needs. We need to work together.”

Lord Peter Smith, Chair of Greater Manchester Health and Care Board

The Greater Manchester Health and Social Care Partnership are working in partnership with other sectors including education and housing to support everything from good eating habits and exercise to education and everyone’s ability to earn a decent living. The partnership is taking action to give children the start they need, support independence in old age, tackle illness earlier on and even prevent it altogether by improving the lifestyles of local people.

Other areas of England are also currently undertaking their own health devolution journeys, including London, West Yorkshire and Harrogate, as well as some other combined authority areas. However, one of the big challenges is that currently, while we can learn from the experiences of those already on their devolution journey, there is no common, consistent or comprehensive understanding of what good heath devolution looks like, full evaluations of the benefits it brings or overarching strategies on how it should be developed.

This is something that will need to be addressed if health devolution is to be successfully rolled out across England.

Final thoughts

Devolution of health to a more local level provides an opportunity to tackle the big public health challenges of our time at source, and to create a better, more joined up community health ecosystem. It also provides the chance to share and collaborate, learning from best practice and delivering improved health and social care services at a regional and national level.

It has been suggested that the coronavirus pandemic, while traumatic in more ways than one for the NHS and its staff, may provide the re-setting point needed to implement some of the changes proposed in relation to greater health devolution. Proponents of this view argue that improved funding to support effective and high quality care, improved integration between health and social care, and greater positioning of health and assessment of the impact of decisions on health across all policy areas, should be among the top priorities as the country looks to recover from the pandemic.

As the Health Devolution Commission underlines:

The pandemic has shown we cannot go back to the way things were. We need a ‘new normal’ and we believe that comprehensive health devolution is the only viable solution to the challenges the country now faces.”

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Can a city ever be truly ‘carbon neutral’?

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Manchester Skyline. Image: Ian Carroll (CC BY 2.0)

This guest blog was written by Joe Blakey, PhD Researcher and Sherilyn MacGregor, Reader in Environmental Politics, at the Sustainable Consumption Institute, University of Manchester.

Upon becoming Greater Manchester’s first elected mayor, Andy Burnham announced his ambition to make the city-region one of the greenest in Europe. In his Mayor’s manifesto, the former MP and Labour leadership candidate, committed to “a new, accelerated ambition for Greater Manchester on the green economy and carbon neutrality”. If achieved, Manchester would be transformed from one-time poster city for Britain’s dirty past to a decarbonised oasis in the post-industrial north-west of England. What it will take to realise this vision was the topic of a “Green Summit” held in Manchester on March 21.

The summit brought together some of the best minds from Greater Manchester’s universities and businesses, local activists and residents to debate how to “achieve carbon neutrality as early as possible”, ideally by 2050. Leading up to the summit, expert workshops and “listening events” were held across the region, in order to inform a forthcoming Green Charter, the plan for how the city will become “carbon neutral”.

We argue that the concept of “carbon neutrality” is a lofty ambition, but it needs unpacking before anyone gets too excited about its potential. The idea that a zero carbon target is the best driver for creating a city-region and a planet that’s inclusive and liveable for all raises important questions.

Understanding carbon

Carbon neutrality, or “zero-carbon”, is a curious term. NASA remarks that “carbon is the backbone of life on Earth. We are made of carbon, we eat carbon, and our civilisations – our homes, our means of transport – are built on carbon”. Even our bodies are 18.5% carbon. Ridding our cities of carbon suddenly seems absurd. Removing the “backbone of our life on Earth” is surely not on Burnham’s eco-agenda. So what does “carbon neutral by 2050” actually mean? Understanding a little about carbon footprinting helps to expose the nuances and silences behind the ambition.

Carbon is emitted at various points within the production, transportation and consumption of goods and services, but establishing responsibility for these emissions depends on your standpoint. Is it the consumer, the manufacturer, the haulage firm, the investor, the source country or the destination country? Our actions and impacts do not respect political boundaries.

Governments typically count carbon emissions following guidelines from the Intergovernmental Panel on Climate Change (IPCC). Taking a “territorially-based” approach, only the direct carbon emissions (and removals) taking place within a certain city or a country are counted, along with those from the production of the energy consumed. “Carbon” stands for a whole raft of greenhouse gases, including CO₂. This approach underpins declarations of successes and failures worldwide, but it’s just one way to allocate carbon emissions. And herein lies the issue.

An alternative “consumption-based” accounting is more often used by environmental NGOs such as the WWF or some parts of the UK government. This approach counts the total emissions from goods and services (including travel) consumed by a person, city or country, regardless of where they occurred. Under consumption-based accounting, eating an imported steak means factoring in shipping emissions, the plastic used in packaging, and the emissions from the cow itself – all of which take place far outside of the typical “footprint”. One recent analysis found a group of large cities across the world emitted 60% more carbon when considered like this.

But will Greater Manchester, the aspiring “Northern Powerhouse”, really want to include emissions from such key drivers of economic growth? The city-region has a busy airport, for instance, that it might be convenient to exclude under “zero carbon”. Greater Manchester’s ambition may be laudable, but the zero-carbon definition risks side-lining much-needed action in other areas.

There is some degree of hope. Greater Manchester is implementing a new standard which extends the IPCC’s approach, also considering emissions from residents’ travel beyond Greater Manchester and waste disposed of beyond the city-region. This is significantly more ambitious than a territorial-based approach. But, even if “zero-carbon” was defined under this approach, there would still be difficult questions as to what extent aviation emissions would be included – if at all – not to mention other consumption-based emissions, such as those from imported food.

Cleaner, greener, and lower carbon

In any case, the city needs environmental policies beyond the focus on becoming “carbon neutral”. Litter is one of the top resident concerns about environmental quality, for instance, while a recent study by MMU’s Gina Cavan found many people in the city have limited access to green and blue spaces. Research by our colleagues found the greatest level of microplastics ever recorded anywhere on the planet in Manchester’s very own River Tame.

No doubt the mayor and his team will be concerned about these other problems too. But the pollution crises and the lack of access to green spaces are questions of environmental injustice, and their root causes will not necessarily be addressed by carbon neutrality. To avoid obscuring other areas of action, it’s vital that claims about a “carbon neutral” future clearly state what they are referring to.

Carbon neutrality doesn’t cover everything – it might only be concerned with decarbonising energy and in-boundary emissions. If Greater Manchester is serious about becoming greener, cleaner and inclusive, then there needs to be accountability for other perspectives on emissions responsibility, including those associated with consumption and aviation.

Joe Blakey is a PhD Researcher at the Sustainable Consumption Institute, University of Manchester; Sherilyn MacGregor is Reader in Environmental Politics at the Sustainable Consumption Institute, University of Manchester.

This article was originally published on The Conversation website and has been republished with permission under a Creative Commons licence. Read the original article.

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Supercouncils: questions raised about new powers for England’s combined authorities

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town hall photo

Image: James Carson

Just over a year ago, Manchester began blazing a trail for devolution in England. Ten local authorities in the Greater Manchester Combined Authority (GMCA) signed a deal with George Osborne, the Chancellor of the Exchequer, for the transfer of powers in areas such as transport and skills from central to local government.

Since then, the English devolution bandwagon has picked up speed. After the general election in May, the newly-elected Conservative government introduced a Cities and Devolution Bill , creating a framework for the transfer of powers to the regions, and making provision for directly elected mayors.

During the summer, the Chancellor invited cities, towns and communities across the UK to submit their own devolution proposals, and by September 38 submissions had been received (including a number from Scotland and Wales).

Meanwhile, further deals have been announced, giving greater autonomy to local authorities in Sheffield, Cornwall, the North East of England and the Tees Valley. In November, two further deals were announced for the West Midlands and Liverpool.

As its momentum gathers pace, questions have arisen over the nature and implications of devolution for England’s cities and regions.

The devolution time frame

In October, a survey for Local Government Chronicle (LGC) highlighted concerns about the devolution timetable. 69% of the 45 chief executives and deputies responding to the survey indicated that the seven-week timeframe given to put a proposal together had been too tight. Of those councils which had not submitted a bid, 38% said they could not arrange a partnership with another authority, while 8% said they could not convince politicians in their area to agree.  However, the survey also indicated that 15% of councils were holding back on bids to see how other authorities fared first.

Accountability, transparency, public involvement

Some of the key governance issues surrounding devolution were considered in a report by the Centre for Public Scrutiny.

The report was critical of the secrecy of the deal-making process, noting that details were only being released when agreements had been reached:

“Local people – anyone, indeed, not involved in the negotiations – need to understand what devolution priorities are being arrived at and agreed on. Increased public exposure in this process will lead to a more informed local debate. At the very least, the broad shape and principles of a bid for more devolved powers should be opened up to the public eye.”

The report argued that governance arrangements for the work that combined authority areas will be doing in future need to satisfy three conditions:

  • Accountability: decision-makers must clearly take responsibility, and engage with those seeking to hold them to account (non-executives, the public, and others)
  • Transparency: it must be clear (to professionals, elected councillors and the public) who is making decisions, on what, when, why and how
  • Involvement: a commitment to public involvement should be seen as central to good governance.

Directly elected mayors

In 2012, plans to replace local council cabinets with directly elected mayors were rejected by voters in nine English cities, including Manchester, Newcastle, Sheffield and Leeds.

However, the government has insisted that devolving powers to English regions is now conditional on the inclusion of directly elected mayors. In May the chancellor explained why he thought this was so important:

“It’s right people have a single point of accountability; someone they elect, who takes the decisions and carries the can. So with these new powers for cities must come new city-wide elected mayors who work with local councils. I will not impose this model on anyone. But nor will I settle for less.”

George Jones, Emeritus Professor of Government at the London School of Economics, has asserted that the concentration of power in one person is undesirable:

“…the advantage of collective leadership is it enables exploration of policy from different perspectives. Colleagues can consider possible impacts of policy in a variety of contexts, spotting pitfalls ahead and the consequences for different people and groups. A single person is unlikely to represent the diverse complexities of a large urban, metropolitan or county region area better than can collective leadership.”

The journey to greater autonomy for England’s regions has only just begun, but it’s already clear that the path to devolution will not be straightforward.

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