Regional devolution could transform the NHS – provided there’s consent

A hospital. Image: Getty.

The Labour MP for Wigan on the need to bring democracy into NHS devolution.

In a few months time, Greater Manchester will make history by choosing its first ever directly-elected regional mayor. Devolution is necessary, long overdue, and cannot be allowed to fail. The pressures in the NHS cannot be solved from Whitehall or Westminster. They can only be solved by people closest to these problems taking charge of their own lives.

Handing powers over transport, homes, policing, skills and the NHS to an elected mayor could profoundly reshape our public services for good, putting people and communities in the driving seat when it comes to choices that affect their lives, not just in Greater Manchester, but across the country.

Greater Manchester is an ideal testing ground to pioneer these radical reforms, in part because of the good working relationships between local leaders, built over decades. But the challenges for health devolution are great. Greater Manchester is a diverse area, facing varied and complex health challenges, from my borough in Wigan with a legacy of chronic ill health from the mining industry, to the challenges of a younger, urban, diverse population in central Manchester.

A&Es are under unsustainable pressure from cuts to social care. Cancer diagnosis is exceptionally poor. There is a desperate lack of support, both financially and structurally, for mental health. And under the terms of the devolution deal, there is a £2bn funding gap. It will take every bit of energy and creativity to solve this, and it must start with the best asset we have – people.

Last week, a new report from the Fabian Society found that, although there is significant support for local leadership in the NHS, more must be done. Too many people do not know what devolution means. They want more information and transparency, especially where devolution is already underway, and protection from postcode lotteries.

More than two years after the health devolution deal was announced in Whitehall and signed behind closed doors in Manchester town hall, the people remain largely shut out of the conversation. The public consultation on these sweeping changes was not properly publicised, ran for just three weeks and received only 12 responses – 10 of them from the same council leaders that signed the deal in the first place. It didn’t even mention the NHS.

There needs to be a cultural shift in the way this process has operated so far. These major health reforms, the most radical and risky to be proposed since the NHS was founded in 1948, have been subject to just one public consultation that ran online and through 10 public meetings across the whole of Greater Manchester. The vast majority of the public are unaware that the consultation "Taking Charge Together" ever happened, only 6,000 people in a population of 2.8m have responded.

Resources should be made available to local communities to get involved in this process and help to shape it. Documents must be cleared of jargon and written in a language that most people can understand. Challenges to the system must be welcomed and embraced, and formalised through a forum that publicly holds the mayor to account. Just as select committees are properly resourced and supported, councillors should be given the skills, time, resources and independence to scrutinise decision making and highlight where decisions are failing us.

In the wake of Brexit, where communities in towns and villages across the country demanded the right to be heard, to ignore this desire for greater power would not just be wrong, but politically catastrophic. Those areas must be given a voice, and more importantly, the ability to hold the mayor to account.

Great Manchester is dominated by Labour representation, but it is essential in a healthy democracy that an individual as powerful as the mayor is scrutinised on a cross-party basis, both to ensure challenge and to give a voice to people across the region who hold different views. Civil society has not been involved or consulted. And so far, there are no plans to change this.

A model that does not have the will and support of the people will not succeed. The UK is inevitably and rightly shifting towards a federal model and getting this process right is critical. That can only mean a mayor who is accountable to and directed by the needs and lived experiences of the people they represent. Real devolution comes from public consent. Democracy cannot be an afterthought.

This article previously appeared on our sister site, The Staggers


You’ve heard of trainspotters and planespotters. Now meet Britain’s growing army of busspotters

Some busspotters in action. Image: Damian Potter.

In the summer of 2014, with too much time on my hands and too little to do, I found myself in the middle of an incredibly active, 200+ person Facebook group. How I ended up here (record scratch, freeze frame) is a little too convoluted and stupid to explain – but what I found was a world that I a) could not have imagined nor b) had any clue even existed.

The group I tumbled into was what I now understand to be a very, very small example of a “busspotting” group – that is, a Facebook group full of dedicated bus enthusiasts which exists to share pictures of buses they see on the road. This group had members from all over the country, with a concentration on northern buses, and was predominantly filled with young, white men.

What I expected to see was a range over relatively interesting buses, holding some significance or another, that were tough to find in your average day-to-day life. This was, largely, not the case. What fascinated me was that the vast majority of the group was not focused on unique buses, new buses, historically significant buses, and so on – but simply on the average bus and or bus route you might take just to get around your city.

What was even more bizarre to me was that people from across the country were meeting up in small towns (Morpeth, Livingston, Stevenage) to take seemingly mundane bus rides to other equally small places (Washington, Gloucester, Grimsby). The busspotters would travel hours on end to meet at these locations simply to ride this bus, often for three or four hours, and experience a bus route they’d never been on before or one that they just particularly enjoyed.

Ooooh. Image: Damian Potter.

After a couple of weeks of silently watching and one semi-ironic post, I left the group. And, for the next three years, I gave barely a thought to bus enthusiasm, as no busspotter group/page/person crossed my path. Unlike similar enthusiasms like planespotting and trainspotting, it didn’t seem to me that busspotting had any significant following.

But, as is the way of these things, a weird thread on Twitter three summers later sparked my memory of my short time in this group. I wanted to see what busspotting was actually and about and if, in fact, it was still a thing.

So I spoke to Damian Potter, an admin on several popular busspotting groups, about what it’s like to be deep into the busspotting scene.

“I used to sit upstairs on double decker buses and 'drive' them, including the pedal movements!” Damian announced right off the bat, speaking of his childhood. “I've been driving coaches at home and abroad since I passed my PCV test in 1994. I've been driving for Transdev Harrogate and District Travel since 1998.”

Damian, as you might have gathered, has been a busspotter since his early youth. Now, at the age of 50, he manages four different busspotting Facebook groupsm, mostly based around the Harrogate area (Transdev Enthusiasts, The Harrogate Bus Company, iTransport Worldwide and Spotting Bus and Coach Spotters). Some of them have over a thousand members.

He also participates in busspotting IRL, travelling around the country participating in busspotting meet-ups and events and co-organising trips along different bus routes. When I asked him what busspotting was to him, he explained that it can manifest in different ways: some people focus on makes of bus and routes, other focus on particular bus companies (National Express is particularly popular). Of course, bus enthusiasm is not solely a British phenomenon, but busspotters can certainly be found in practically every corner of the UK.

“People tend to think that spotters hang around bus stations furtively, with a camera and some curly cheese sandwiches, but this isn't really the case,” Damian continued. That said, he also mentioned some particularly hardcore bus nuts who have been known to trespass on company premises to be the first to snap a picture of a new bus.

“They really do produce some brilliant pictures, though,” he added.

Although much of busspotting culture happens online, predominantly on Facebook, groups often have what are called ‘running days’ which involve meet ups having to do with particular routes. Damian mentioned one particularly popular day following the London Routemaster buses that happen periodically. Not only do these routes draw in enthusiasts, he noted, but also draw huge numbers of tourists who want to claim they’ve ridden on the original London buses.

“I reckon the general public miss the old Routemaster buses. There is only one 'heritage' route in London which still uses Routemaster buses and that's the 15 service between Trafalgar Square and Tower Hill.”

Despite this widespread interest in buses and bus history, though, busspotters often find themselves treated as the lesser of the motor enthusiasts. This became clear to me almost immediately when speaking to Damian, and continued to strike me throughout our conversation; without my saying anything sarcastic, malicious, or snarky, he became instantly defensive of his fellow enthusiasts and of his hobby.

When I asked him why he felt this immediate need to defend busspotting, he explained that people often ridicule busspotters and bus enthusiasm generally, arguing that bus drivers are the most common attackers. “However,” he noted, “if I bring a load of pictures into the canteen they're the first to crowd around to see bus pictures...”

Aaah. Image: Damian Potter.

Despite being perceived as an often-mocked hobby, bus enthusiasm is expanding rapidly, Damien claims. “The bus enthusiast culture is growing, with younger generations getting more involved.” Drawing in new, younger enthusiasts has become easier thanks to social media, as has creating real personal connections. Social media has made it easier for bus enthusiasm to not just stay afloat, but actually thrive over the last several years.

It’s so widespread, in fact, that a national competition is held every year in Blackpool to mark Bus Driver of the Year (Damian himself came in 34th out of 155 back in 2002). This event draws in everyone from the bus world – drivers, manufacturers, tour companies, and enthusiasts alike. Here is one of the many places where great friendships are forged and busspotters who’ve only known each other online can finally meet face-to-face. “Personally I have made some great friends through Facebook,” Damian told me. “I have even stayed over at a friend's house in London a couple of times.”

Busspotting may be less well-known than motor enthusiasms like planespotting and trainspotting, but that very well could change. Thanks to active social media groups and regular in-person meet-ups, people have been able to use busspotting forums as not only a way to find lifelong friends, but also spend more of their free time exploring their hobby with the people they’ve met through these groups and pages who share their enthusiasm. For all the flack it may receive, the future of busspotting looks bright.

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