John Blundell speaks to Lord Peter Smith, former Wigan council leader and the region's lead on health

“The NHS is the closest thing the English people have to a religion” – Lord Nigel Lawson

Lord Peter Smith of Leigh was the leader of Wigan council from 1992 to May 2018, making him the second longest serving council leader in British history. 

As chair of the Greater Manchester Health and Social Care Partnership he is also the region's lead for health, having overseen the devolution of health and social care following the initial devolution agreement in 2016.

Despite it being our most precious public institution, it still seems that the majority of the public are still unaware that our hospitals are no longer under the ward of the Secretary of State, but the Mayor and the GMCA (Greater Manchester Combined Authority), and that this is unique to Greater Manchester - no other city has been granted such control.

For this reason, I went to meet Lord Smith to ask him what exactly is being done with our NHS.

The NHS is a wonderful institution, but we are in danger...

Firstly, you've stepped down as council leader, so what is now your role?

LPS: "In 2014 we got the big devolution deal for Greater Manchester and we successfully negotiated devolution of health from the 1st of April 2016. Each leader within the Greater Manchester Combined Authority (GMCA) got a task and mine was chair of the Greater Manchester Health and Social Care Partnership. In May, before I stood down as leader, I had a conversation with the Mayor (Andy Burnham) and said I am happy to continue my role in health.

What is the point of NHS devolution, what are the tangible benefits to patients?

LPS: "If you look at a lot of Greater Manchester's health stats they are pretty poor - what is going on here? It is partly because the health service needs improvement but also because of the way people live. It has become an ill-health service, you only use it when you are ill, but how do we stop people becoming ill in the first place? 

When we took over in 2016 we produced a plan called 'Taking Charge'. It's about taking charge of your own health responsibilities. Are people doing the right things? The schemes that we do for cycling and walking, these are all useful to the NHS."

Nhs Manchester Mri
In April 2016, Greater Manchester's £6bn NHS budget was devolved to local authorities

Is the integration of services actually working - like combing the NHS with adult social care?

LPS: "Integration is key to getting the health system to work better. What I discovered was a lack of integration within the health service itself. Hospitals don’t talk to one another, or to GPs. It isn’t just integrating adult care but getting everybody working together. The NHS is a wonderful institution, but we are in danger. All political parties believe we can make the NHS better if we give it more money, but you'll never do that."

What is stopping the councils saying: ‘this has health benefits, so let the NHS pay for it'?

LPS: "We (the councils) are all hard up, often we can make changes now that do produce short term savings. Like in Wigan with the Wigan Deal, we have a much different conversation with people and do early intervention and prevention work with them, that’s how we kept council tax down and never used reserves. Instead we paid smaller amounts upfront."

But will the NHS be paying?

LPS: "Some of it will be for us, some of it will be for them. Organisationally that is tricky, to get money out of health, but we are beginning to do that. Some acute hospitals will be setting up nursing homes so that they can move people from hospital beds to the home. We save money and, more importantly, it's better for the patient.

There is one hospital where the door sizes are too small to get modern beds through...

With this osmosis of funds, how can the public be certain that health money is being spent on health and not on council services?

LPS: "I think what people want is the care they need, when they need it. What is underlying your question here is, and I agree, that people have a belief in buildings, which is wrong, when they should think about care. We are doing a review now of services across the acute hospitals, because it is unsustainable as it is, not just financially but also with staffing.

"There is a great model here in Greater Manchester with the Christie. If somebody you love ends up with cancer do you want them to see a local doctor in Rochdale, who might see something like this every blue moon, or a specialist at the Christie who sees it three times a day? What the Christie have done is open in Oldham, so you can get it done on a local basis. but we need to use the world class centre. If you need specialist treatment then get the best. If you need on-going care it can be done at your convenience in a local hospital."

Lord Peter Smith Andy Burnham
Lord Peter Smith alongside Mayor Andy Burnham

So will there be a cull of buildings?

LPS: "We are carrying out an estate review in Greater Manchester. We need to do that and get rid of surplus buildings. Some buildings are beyond economic repair, some are Victorian. There is one hospital where the door sizes are too small to get modern beds through. I am radical in this sense, we do need good local facilities and I am not advocating that everything comes to central Manchester, but things should be in appropriate places. I have been through the Christie and I am very grateful. What do we want? To sit in our local hospital for four hours for them to go ‘I don’t know what to do with this person'. No."

The NHS was only devolved here for five years. Are you confident this will continue and how painful will it be to unpick if the government change their mind?

LPS: "Without being immodest, the health system here is making more progress than the health service in England. This is a result of devolution and a partnership of our organisations working together, forming a partnership and sharing ideas. It would be an absolute tragedy if it was stopped. Without devolution, you can’t do this type of work, it is improving things here in Greater Manchester."

John Blundell is a Labour councillor for Smallbridge and Firgrove and theCabinet Member for Regeneration, Business, Skills & Employment on Rochdale Council. He is a graduate of Economics from the University of Manchester and was elected to Rochdale Council at just 20 years old.