Labour's candidate for the Greater Manchester Mayoralty Andy Burnham, right, peers into the kitchen during a visit to the Barnabus Centre in Manchester | Dave Thompson/Getty Images New UK health model hinges on Manchester election Shadow Home Secretary Andy Burnham is the favorite to win in Greater Manchester, and he’s got bold plans for health care.

LONDON — He was once the country’s health secretary and came second to Jeremy Corbyn in the Labour party leadership contest. Now Andy Burnham is the favorite to become the first elected mayor in Britain to have genuine power over health care reforms.

With England’s National Health Service facing a £30 billion budget black hole by 2020, Thursday's race to become mayor of Greater Manchester marks the beginning of a crucial experiment to determine whether the country will be able to make a success of a new model in which important spending decisions on health care could be increasingly devolved to the regions.

Six regions in the U.K. held elections on Thursday to elect a new cadre of regional bosses, who will have more significant powers than Britain's traditional ceremonial mayors. The aspiration is to eventually create regions where the mayor takes an influential role in guiding policy, just as London's Sadiq Khan does today.

Of the U.K.'s new devolved “super-regions,” only Greater Manchester in the northwest has negotiated with the government for more control over running its health and long-term social care services.

Social care in the U.K. refers to care in the community for elderly, disabled and young people, and local governments are responsible for paying for it. Health care is nationally funded but limited to general practice and hospital care.

Burnham has slammed the ruling Conservatives in the central government for entrusting too much to the private sector.

This area of 2.8 million people makes a perfect testing ground for regionalization, as it desperately needs to improve some of the worst health care standards in the country. Once a heartland of the industrial revolution, the decline of textile mills in Greater Manchester has helped create some of the most deprived areas in England, including parts of Rochdale and Oldham.

Last year, Greater Manchester gained full control of its £6 billion annual budget for both health and social services. The new mayor will have to steer reforms to shave £2 billion off health spending over the five-year period leading up to 2020-21.

Political heavyweight

As the only candidate with cabinet-level experience of running the health service, all eyes will be on Burnham, a political heavyweight and current shadow home secretary from northwest England, to win the election and revive the health system.

Burnham has slammed the ruling Conservatives in the central government for entrusting too much to the private sector. He has pledged to “roll back the privatization of services, train more home-grown staff and free our hospitals from this vice-like grip of private staffing agencies."

The need for domestic talent in the health sector will be even more pressing after Brexit, since Prime Minister Theresa May has committed to cutting immigration to the tens of thousands. More than 100,000 EU nationals work in the health and social care system in England.

“I want to build here the country’s first National Health and Care Service by bringing social care out of the private sector and into the NHS," Labour's Burnham said last year when committing to run for mayor. "I will show that only the party which created the NHS in the last century can be trusted to rebuild it."

Burnham's proposal to pull social and health care together under one publicly funded service in Manchester is significant.

Separating health from social care was one of the flaws in the formation of the NHS in 1948, according to Martin Gorsky, professor in the history of public health at London School of Hygiene and Tropical Medicine.

"That's where this idea of bed-blocking [elderly but not critically ill people stuck in hospital beds] and tensions between the health and social care systems began," he said. By pooling these services under one authority and one budget, the hope is that these tensions will fall away.

The big accusation from the likes of Burnham is that the privatized social care system, increasingly privatized services in the NHS and a complex web of service providers results in money being wasted as it passes down the system to agencies and sub-contractors.

And local experts believe Burnham stands a good chance of changing this system.

“For people in Manchester it would be extraordinary if Andy Burnham didn’t win," said Kieran Walshe, professor of health policy and management at the University of Manchester. “The mayor will undoubtedly have an influence over health and social care policy development that we haven’t seen before in the U.K."

Bookmakers put Liberal Democrat candidate Jane Brophy in second place behind Burnham, followed by the Conservatives' Sean Anstee. They are both local councilors. Anti-EU UKIP, the Greens and various independents trail far behind.

Under Greater Manchester’s deal, one authority — the Greater Manchester Combined Authority — now receives the total health care, public health and social care budgets. This is intended to greatly improve efficiency. Instead of dozens of local groups planning and buying health services and local councils paying for public health campaigns, the single combined authority is now the only the decision-maker and purchaser.

To limit costs, the region will use its new powers to pool spending on public services such as housing, policing, health and social care, and reallocate funds as needed.

Limits of devolution

Devolution can, however, only achieve so much within the limits of the deal, argues the Institute for Public Policy Research.

In a report last month, the IPPR called for further powers to be devolved. It said the mayor, as opposed to Health Secretary Jeremy Hunt, should be accountable for the National Health Service in the region — meaning more immediate control of family doctors and hospitals on matters like doctors' wages and targets for waiting times. The region should also be able to raise revenues locally to boost the coffers for services, the report said.

“Devolution isn't real devolution until we have the powers to raise or lower taxes locally” — Liberal Democrat candidate Jane Brophy

“This lack of real decentralization might make it harder for local areas to unlock the potential benefits” of health care devolution, the paper said.

Both the Tories' Anstee and Brophy of the Lib Dems support wider powers to adjust local taxes, such as implementing sugar or fat taxes or imposing more levies on cigarettes. “Devolution isn't real devolution until we have the powers to raise or lower taxes locally,” Brophy said.

But the two diverged on their approach to NHS accountability, with Anstee supporting regional accountability under the leadership of the mayor, but Brophy opposing it.

Burnham’s campaign calls for the mayor “to take the lead on building a healthier society and reducing health inequalities,” but falls short of calling for the region to wrest full accountability for the NHS from Hunt.

Meanwhile, both Burnham and Brophy of the Lib Dems are calling on the government to properly fund the NHS. Brophy has called for a penny on income tax to raise cash, while Burnham has launched a petition on his campaign website for more NHS funding.

At the time of writing, it had just 90 signatures.