Health devolution

MQT on 2015-03-25
Session date: 
March 25, 2015
Question By: 
Andrew Boff
GLA Conservatives
Asked Of: 
The Mayor


Given that Manchester recently received a dose of health devolution, does the Mayor think that London could also benefit from some form of health devolution?

Supplementary Questions: 


Answer for Health devolution

Answer for Health devolution

Answered By: 
The Mayor

Boris Johnson (Mayor of London):  Victoria, I thank you for all your work that you have done on health.  You have been an absolute stalwart and fantastically knowledgeable and passionate about this subject and it has been greatly to the benefit of Londoners that you have been able to help me on this issue. 


There is a great prospect now for devolution of health.  It is something that we need to work at very hard in conjunction with the boroughs to understand what can be achieved and what is reasonable.  Let me put it this way: there is a certain amount of anxiety at council level about the devolution of acute care.  It would be fair to say that it is the case that London boroughs, Mayor Jules [Pipe, Chair, London Councils] and colleagues do not yet feel they understand.  The implications of it are very considerable. 


The situations in Manchester and London are very different.  The health economy in London, as everybody knows, is massively in deficit.  The first question that the Government would put to us were we to take on healthcare in London is, “How will you deal with the huge health deficit?  How are you going to tackle that?”  We need to have a good answer to that.  I do think there is scope for progress in primary care.  I do think there is scope for amalgamation and for co-operation between primary care and social services.  These are areas where the boroughs together with City Hall can make progress.  There is an offer to be made. 


What we are doing, as you know now, is to work with Government, to talk to Simon Stevens [Chief Executive, NHS England], whom I have known for many years, to understand what Manchester is getting because, to be frank, there is quite a lot of confusion about that at the moment and what, if anything, is the read-across for London.  What kind of offer should London now be making?  What should we be aspiring to?  My feeling at the moment is that it should be in the area of primary care and the economies that are to be made between primary care and social services and working with the boroughs to put forward a package for that type of devolution.  If we were to go for the whole thing and to bite it off in one chunk, ultimately, that is the way to go, but at the moment there are some very big questions about funding that are as yet unanswered. 


Victoria Borwick AM [on behalf of Andrew Boff AM]:  Thank you, Mayor.  Of course the question was originally asked by Andrew Boff, who is particularly keen on devolution and has always spoken up on that point and how important it is to devolve decision-making to the closest and easiest area for making those decisions in order to make it the most effective.  I think he was very concerned that around this horseshoe we should speak up in favour of devolution.  Of course, as you say, Greater Manchester will become the first English region to get full control of its health spending and we would very much welcome continuing to see that sort of investment in London’s healthcare, particularly bringing together, as you say, primary care so that we can do something about bringing together the budgets, which are in the care of the councils, and the health, which is obviously still with the National Health Service (NHS).  Many people who are caring for people at home or have other caring roles will know that the problem at the moment is you need to put the patient in the middle and have an opportunity of sharing the care and the budgets for both the social care and the healthcare, and that at the moment is causing great anxiety to many people. 


Back to the point that Andrew [Boff AM] made, I think he wanted to make sure around this table that we do all call out for further devolution gradually over time as it becomes appropriate for London.  I think Andrew was very disappointed to see that Andy Burnham [Shadow Secretary of State for Health] had come out against the Manchester plan for devolution. 


Boris Johnson (Mayor of London):  Yes.  I was not sure how strongly he had come out against it. 


Victoria Borwick AM:  All I know is that Andrew wishes me to raise that because he wanted to hear from you. 


Boris Johnson (Mayor of London):  I am not certain that that is exactly what Labour in Manchester is saying.  Richard Leese [Sir Leader, Manchester City Council] and others might find that a bit confusing.


Victoria Borwick AM:  I think Andrew is a staunch advocate of devolution.


Boris Johnson (Mayor of London):  I do not know what the view of London Labour is about that.  As far as I understand the position of London Labour, London Labour is progressive on this and sees the logic of devolution.  If Andy Burnham really did come out against what was proposed in Manchester, that was a mistake and one which Labour will pay a price for.


Victoria Borwick AM:  I am sure.  Anyway, I wish to put on the record that Andrew Boff is very keen on devolution.


Boris Johnson (Mayor of London):  Thank you.