While Labour will be desperate to push the NHS to the centre of the general election campaign, and the Liberal Democrats will be emphasising their commitment to mental health services, it is the six regional mayors being elected for the first time in May who could provide the biggest surprise when it comes to health policies.
The exact powers of the six – covering Tees Valley, Greater Manchester, Liverpool city region, West Midlands, West of England and Cambridgeshire & Peterborough – vary depending on the deal each region reached with the government, but none of them will control the NHS.
However, like any self-respecting local politician, the candidates are not allowing the limits of their formal powers to deter them from trying to influence such an important policy area.
The manifesto of Andy Burnham, Labour’s candidate for mayor of Greater Manchester, typifies the influence mayors intend to wield. Burnham wants to cut waiting times for child and adolescent mental health services, manage the transition from child to adult mental health services more effectively, have a plan to get local people into NHS jobs, provide more incentives for services to shift from treatment to prevention, and “introduce in Greater Manchester the country’s first fully-integrated National Health and Care Service, building on the work that is already ongoing”.
This tone of his promise on integration implies a clear leadership role for the mayor in health and care policy, well beyond their formal position as just one of many members of the region’s health board.
With these devolved health powers, the temptation for Manchester’s mayor to get involved in broader NHS policy will be irresistible – especially if the winning candidate used to be health secretary. The city region is likely to become the test of how much power regional mayors can exert over health.
Mayors could easily derail STP plans without any obligation to provide a coherent alternative
If the mayor emerges as a driving force for the region’s ambitious health devolution plans – perhaps acting as a broker in disputes and providing reassurance to the public over service changes – then the NHS may begin to see advantages in metro mayors having a more formal role in local health plans. But NHS England will be wary of anything that reduces its firm, if usually discreet, grip on the Manchester experiment.
In the other regions, amid inevitable controversies over sustainability and transformation partnership (STP) plans to move and close services, a metro mayor’s intervention could prove decisive in influencing public opinion. Free of the requirement to make the tough choices, mayors could become a rallying point for public dissatisfaction with local health services.
The implications of this could be far-reaching. Mayors could easily derail STP plans without any obligation to provide a coherent alternative. This could leave NHS leaders in the position of having to either rein in radical changes essential to long-term clinical and financial sustainability, or force through unpopular plans and stand accused of damaging services.
Exerting power without assuming responsibility would be the worst outcome for the NHS from the introduction of metro mayors. STP leaders need to make sure this does not happen. They need to recognise the importance of these new powerbrokers and engage with them quickly and openly. That means listening as well as telling.
It is an opportunity to involve them in key aspects of STP plans, such as tackling the root causes of health inequality and improving mental health with the help of major local employers.
NHS England and NHS Improvement will also have to make some accommodation with this new political reality. They have an important role in ensuring mayors understand the context in which STP plans have been put together, the guidance that local leaders are having to follow, and what clinical and financial sustainability looks like.
Whatever the devolution deals signed with the government say, the NHS will have six new leaders on 5 May.