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08.11.16

Incoming Manchester mayor must care about health, DevoManc boss argues

Regardless of who is elected next year as mayor of Greater Manchester (GM), it is crucial that they fully support the region’s ongoing health and care programme, the new chief officer of GM Health and Social Care Partnership has said.

In an exclusive interview with PSE about the region’s integration journey, Jon Rouse argued that mayors can bring real authority to a region, even if they do not have formal powers over health.

“Without in any way pre-empting the outcome, because we don’t even know who the candidates will be yet, what I will say is – and remember I have a lot of experience working with the London mayor because of my time as CEO of Croydon – that the mayor can bring real authority and clout because of the democratic legitimacy which they will have in representing the people of GM,” he explained.

“And although the way that the mayoral system is set up in GM means they won’t have a direct responsibility for health, I would want them, whoever they were, to be exercising leadership in this area, and providing advocacy and some contribution to direction. Why wouldn’t you, frankly? I want a mayor who cares about health.”

Rouse also emphasised that whoever the forthcoming mayor may be, they will be presiding over more than 25 years’ worth of complex integration experience in GM.

“When Thatcher broke up the Greater London Council and at the same time broke up devolution authorities that existed at that time, GM made the decision to continue to work together, and created the AGMA [Association of Greater Manchester Authorities],” he continued.

“That was at work for almost 25 years before the combined authority was created in 2014, and they did many things: the Commonwealth Games, the airports, the trams, special planning, the University Corridor. These were all GM programmes done under the auspice of AGMA.

“So when you come then to the combined authority in 2014, the devolution deal and the breakthrough, it had all these layers of experience and confidence that had been generated over 25 years. I believe that other areas of the country will and can get to devolution, but they don’t all have those layers of sediment – that history that gives confidence about relationships.”

Devolution or delegation?

Asked about claims that integration in GM is closer to delegation than actual devolution, Rouse argued that there is a “technical answer” and a “real answer” to this question.

The technical answer is that what the region currently has is powers and resources delegated to GM. But because of changes made through Section 75 regulations, the region also has “much more freedom about how we then pull those resources, and how we move them within the system”.

“And that is real devolution. It may start with delegation, but then that moves into devolution,” he argued.

“But the real answer to this is that devolution is a cultural change. It’s not a technical change. Whether we use the Devolution Act or whether we use delegation under NHS England powers is, for me, a secondary question. What really matters is what the ethos is in terms of how the partnership works and behaves, and how decision-making is genuinely shared.

“Also, do NHS England in particular, but also NHS Improvement and Public Health England, give us the space to do things differently and to come up with different solutions? And I have to say that, up to now, they have all been absolutely as good as their word. Between them, they have been super facilitative in allowing us to make different choices and trying to facilitate that to happen.

“And if that is the ethos, then it doesn’t matter that much what the technical mechanism is – it’s actually about behaviours and culture and innovation, and the appropriate level of risk-taking, and about sharing problems and solutions.”

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