On Monday, Andy Burnham, Our Prime Minister in waitingdefined his vision for the country.
At its heart is a devolution revolution – a massive shift of power away from Westminster and Whitehall to local communities. It is exactly the kind of bold reform we need to overcome decades of decline.
I still work as a GP as well as MP for Stroud, and on the train back from Manchester I started to think about what Manchesterness might mean for our health service.
The three NHS mantras: cure for prevention, hospital in the community and analogue to digital are all laudable, but delivery is harder than rhetoric.
And delivery requires one thing above all: real devolution of power, budgets and control.
Neighborhood health centers offer a way to deliver these changes, but there are risks. I read today that hospitals are bidding to do GP surgeries. That would be a disaster. We need to shift funding towards community care, but the reality is that this is not happening.
So what can we do?
In Stroud, I ran a country-based NHS that was centered around patients rather than just hospitals. There was a plethora of people and organizations on our board.
GPs, district nurses, health visitors, mental health and social care workers, physios, hospital consultants, paramedics, dentists and, yes, the patients themselves, were all sitting around the same table. But on top of that we had food producers, housing specialists, park managers, DWP workers, artists, educators, religious leaders and social enterprises.
What we achieved was extraordinary. In Stroud, there is now a network of nine community centers based in the most deprived areas of the district. They work with food banks, GP surgeries, mental health support workers and wellbeing advisers. We’re putting care right where patients need it: at the heart of the community.
Last week, I spoke to an MP who said she didn’t really have a clue what “community” meant. To be honest, it can be used as a nebulous word – a good thing, but difficult to define.
What I realized is that community is a set of relationships. It is over coffee after meetings in Stroud where the plans are drawn up and the real change happens.
The point is that the people who provide care are divided among many employers. GPs, community nurses, mental health services, social care and hospitals all operate in silos. This makes true integration nearly impossible.
We need unified budgets, devolved locally, giving communities the power to design services around people.
The gains would be substantial. When mental health professionals work directly out of GP surgeries, productivity can triple. Patients are seen earlier, faster and more holistically.
Social care should follow the same logic. The current model, shaped by Thatcher’s legacy, is inefficient and absurd. Caregivers travel miles, while the frail neighbor who lives next door receives visits from completely different agencies.
It doesn’t make sense. Care must be organized locally, delivered locally and rooted in the communities it serves. In the long term, this means moving towards a National Care Service.
We also need to rethink access. Local health centers and minor injury units can provide care late into the evening if we move resources away from hospitals and into neighborhoods. Keep A&E to true emergencies, but treat people closer to home wherever possible.
And most importantly, we must abandon the idea that one size fits all. Different countries have different needs. Transfer allows flexibility while maintaining national standards. Everyone should have access to high-quality care locally, but the way that care is delivered should reflect the community it serves.
This is the promise of Manchesterism to the NHS. A system where power is reduced to the local level. Where prevention takes priority. Where care is built around relationships and where patients receive high quality treatment close to home.
Without that change, nothing really changes. Hospitals will continue to absorb most of the funding, A&E waits will increase and outcomes will stagnate.
But with it, we have a chance to build an NHS that is truly rooted in the communities it exists to serve.
