Last week George Osborne (below) announced that from 2016 Greater Manchester’s combined authorities will take responsibility for the area’s entire £6 billion health and social care budget.

The deal is being hailed by council leaders across Greater Manchester but Andy Burnham (right) is urging caution and warns that the proposals could lead to a break up of the NHS and an inconsistency across the country in the provision of health and social care.

This is a massive change to the way healthcare is funded in England and the proposals need to be critically analysed to see if the argument that it will improve health outcomes for the people in the area really do add up.

The slogan in the agreement to be signed by all parties and drawn up by the Treasury says: “There will be no decisions about Greater Manchester without Greater Manchester.” Sound familiar? Well it should.

In 2010 Andrew Lansley the then health secretary justified his massive reorganisation of the NHS with the slogan “No decision about my health without me.” We now know how hollow that promise was.

The massive and costly reorganisation imposed by the coalition government has not only plunged healthcare into its greatest crisis since 1948 but the patient has far less say or control over their care.

This government has rolled out many Trojan horses in its five years in power. Like a typical, reactionary propagandist, they adopt benign and often progressive language to disguise their real intentions.

They told us that local government reorganisation would increase local community involvement and changes to the NHS would improve care standards and give the patients a major voice in their health and wellbeing.

The truth has been very different as each initiative has been about cutting services, increasing the scope of the private sector and reducing local accountability and scrutiny.

So what should be the unions’ response? Well devolution of power and resources to local areas can bring positive benefits. There needs to be more local involvement, including a role for patients, staff and carers in the provision of services.

Nobody can argue that the current provision of health and social care is acceptable or that merely reverting back to the 1948 setup will deliver better outcomes.

Change will be necessary but a lot more detail and information needs to be provided before any real analysis as to whether these proposals will deliver the targets claimed.

Reading the information currently available raises a number of concerns.

First, the speed being proposed to introduce the changes. Hasty change usually makes for instability — just look at the last reorganisation of commissioning in the NHS.

There is little detail as to how the Joint Commissioning Board (JCB) will be elected and how it will make decisions. Since the creation of the Clinical Commissioning Groups (CCGs) more and more decisions on commissioning services are taken behind closed doors.

The proposals say that provider organisations will need to be involved in co-designing services. How will this work and what will the impact be on services in localities?

Although the agreement states that NHS England will devolve the entire £6bn budget to the Greater Manchester JCB, in other parts of the agreement it refers to NHS England devolving finances to appropriate bodies. Who are these appropriate bodies?

It appears that the region will also have control over staffing including capacity and training. How does this fit within the national framework?

The big catch is that the devolution is predicated on the region having a mayor. Apart from the concern of concentrating this amount of money and power in a small group of individuals, the imposition of a regional mayor raises real questions about local democracy.

Manchester and other Greater Manchester councils have rejected the concept of city mayors. Yet if this agreement is implemented then a mayor will be foisted on the region. In addition the interim mayor will be unelected and will still be able to make crucial decisions concerning the region’s health and social care services.

The labour movement needs to set out a clear vision for an alternative. It is not good enough to rely on the current Labour Party policy that merely says that there will be increased spending and more GPs and nurses.

We need a plan to reflect the needs of the communities we live in. It must be an integral part of the national structure for delivering comprehensive, consistent health and social care, whether it is in Cornwall or in Newcastle.

The system must be democratic and accountable to the local community.

Beware of Tories bearing gifts. We need to organise for genuine change, change that will benefit all the people.

This article first appeared at unisonactive.blogspot.co.uk