Are you a clumper or a splitter?

On February 25th it emerged that local authorities, clinicians and George Osborne, the chancellor of the exchequer, were proposing to transfer control of the £6 billion ($9.3 billion) of public money spent on health care in Greater Manchester to local hands. They want to create a health and wellbeing board, made up of NHS and local-government representatives, to administer a single budget for the conurbation. A trial version is expected to take shape in April. 

The city region’s doctors and hospitals will still be bound by national targets for things like waiting times, and subject to national regulations and inspections, but the board is a welcome idea nonetheless. It is bottom-up, pushed by local figures rather than imposed by the government, and it advances two positive trends.

The first is the integration of health and social care. Long-term conditions like diabetes, dementia and depression are now responsible for 70% (and rising) of Britain’s state health-care spending. They require a mixture of medical and non-medical attention.  

The second positive trend is that regional conurbations are becoming more powerful. Manchester has led the way: in 2011 ten local councils in and around the city formed a “combined authority” to manage services and infrastructure jointly.

But the initiative will also test Britons’ willingness to tolerate regional variation (or “postcode lotteries”, as tabloid newspapers call it). Andy Burnham, the opposition Labour Party’s shadow health secretary, warned that Manchester’s proposals could turn the NHS into a “Swiss cheese”, with some parts more autonomous than others; taking the “national” out of the National Health Service. 

The newspaper concludes:

Public services can be nationally uniform or locally accountable. They cannot be both.

Whether you live in the UK or not, what's your take?  Is this a good approach or not?  How would you measure success? Does it matter whether we consider the short term or the long term?