A former Whitehall health mandarin has warned that devolution could be ‘a Trojan Horse’ for spending cuts and raised fears that councils might divert health funding to transport budgets.
Sir Hugh Taylor, former permanent secretary at the Department of Health and now chair of Guy’s and St Thomas’ Hospital Trust, told a King’s Fund debate this week on integration: ‘There is a phrase “beware of Greeks bearing gifts.” The question to ask is whether devolution is a Trojan Horse.
'Successive governments have a record of handing down services to local government and then capping budgets.'
He added: ‘I’m nervous that we’ll be trading road maintenance services for health as cash limits bite. My worry is that mixing up budgets will lead to reductionism not improvement. Devolution mustn’t displace the big issues facing health where we are still trying to run the cheapest system in the developed world and making savings.’
Sir Hugh, who stepped down as permanent secretary in 2010, also said that health and care integration in Greater Manchester and Cornwall were not ‘easily replicable’ elsewhere.
He added: ‘We mustn’t assume that what happen in Manchester and Cornwall can be replicated elsewhere. It’s not a magic bullet but the result of hard work. What stands out in Manchester is the continuity of leadership. It’s not easily replicable nor would it easy to know which geography is right for it.’
Wigan MBC leader Lord Smith, chairman of the Greater Manchester Combined Authority, said devolution had to happen because the existing structures ‘aren’t good enough’ and he denied that the Government was insincere about devolution saying George Osborne ‘is genuine.’
Lord Smith added: ‘I get accused of doing the Government’s dirty work. But local people think it’s better that decisions are made by people accountable to them rather than by a bunch of civil servants in Surrey.’
He said Greater Manchester was ‘on course’ to deliver integrated health and care by next April.
Social care minister, Alistair Burt, told the seminar: ‘Devolution has caught the imagination but central government has to make sure its priorities aren’t lost while you also need local choice.’