Devolution may have failed in New Labour’s hands but it can and must succeed – we just need a different mindset, writes Andrew Lansley
When John Prescott was pushing for regional assemblies across England, I was called up as an MP by Labour’s market research company.
They asked for my views on a regional assembly, including asking how I would describe the region in which I lived. I said I was against regional assemblies and that I lived in East Anglia. “Oh, no, we can’t code that,” they said. It was not the answer they wanted; instead they wanted six-county terms, like East of England or Eastern England.
Labour’s plan for the regions failed. It failed in the East because it did not reflect our identity, it failed in the North East because it didn’t bring added value and it failed generally because no one could see how it would be accountable.
The three principles of devolution
Devolution is nonetheless a principle in which I have believed for 30 years. As deputy director general of the British Chambers of Commerce, I saw at first hand how our centralised state repeatedly sought to impose structures on the business community (local employer networks, training and enterprise councils, regional development agencies, Business Link), but never to support the business community’s own longstanding representative bodies, the chambers of commerce, to grow into the role.
There must be the point at which the government lets go.
When it does, devolution has to rest on three principles: identity, accountability and additionality. The devolved forms of government must be those with which people will identify, structured so that someone can be held to account and capable of adding value and benefit to those it serves.
When I was at the Department of Health, I applied these principles in health reform. The public expects general practice to be responsible for its care, and I gave GPs the opportunity to bring their clinical skills and leadership, with their understanding of population health management, to add value in commissioning healthcare
I have seen it recently argued that “devo Manc” is a reversal of these reforms; that is completely wrong. The reforms enabled this devolution
I left GPs free to structure from the bottom up. I maintained national funding, standards and the adherence to NHS values of a comprehensive, free service. We recognised, however, that accountability and added value would also derive from creating a new partnership between the NHS and local government.
In particular, the new health and wellbeing boards would bring health, social care and public health responsibilities together in local strategies.
I have seen it recently argued that “devo Manc” is a reversal of these reforms; that is completely wrong. The reforms enabled this devolution. Clinical commissioning groups now have the statutory freedoms to combine on the geography of their choosing, the flexibility to work with local government, a duty to work to a shared strategy and the ability to pool budgets and create joint commissioning bodies.
The requirement on the NHS at any level is simply to ensure that quality and outcomes are improved and that clinical standards and NHS values are sustained, and these do not prevent joining in new accountability mechanisms.
Devolution, in practice, provides an inherent gain in potential effectiveness, giving local people the ability to work together across boundaries to deliver shared solutions. Those boundaries are not just geographical, but organisational and professional. The latter can frustrate integrated services.
Remember when Alan Milburn announced children’s trusts? Under that organisational umbrella, the professional and funding silos never changed, the national controllers never let go and the opportunity for services integrated around children and families was not realised.
The government’s enthusiasm is motivated by a powerful sense that Britain can be stronger if we harness the full potential of each part of our country
Similarly, the push for health and care integration will not be realised solely by organisational change. It demands the breakdown of professional, funding and regulatory boundaries. Joint commissioning needs providers and professionals equally to reshape their services. Those boundaries will be superseded when personal budgets in social care are combined, in the hands of care users, with a health-related entitlement.
The government’s enthusiasm is motivated by a powerful sense that Britain can be stronger if we harness the full potential of each part of our country and that the surest route to success is by giving the people there the power to shape, promote and build their communities.
The devolved administrations are the prime examples and the degree of devolved powers is a reflection of each of their identities. Within England, the potential of city regions to realise added value, with a shared identity and new clear accountability, is developing strongly.
In English county areas, the issues of identity and accountability can be a lot less straightforward. I recently supported the proposal for Cambridgeshire (where I live) and Peterborough to join Norfolk and Suffolk to create a combined authority.
My initial motivation was about additionality. The “Cambridge effect” is generating economic dynamism and dramatic demand for housing, jobs and infrastructure in an area around Cambridge, including parts of Essex, Hertfordshire, Norfolk, Suffolk, and Peterborough. Developers and investors will be enthusiastic to come south of Cambridge, but the potential of the region cannot all be accommodated in the M11 corridor.
The greatest unrealised potential for growth lies in an arc from Huntingdon, to the north-west of Cambridge, to Haverhill to the south-east. With the right infrastructure, this could create hubs for growth in towns like Ely, Thetford, Downham Market and Bury St Edmunds, as much as in Norwich and Ipswich. It would not be a conurbation, like the city regions are, but a connected region, uniquely combining the quality of life of our wonderful East Anglian landscape with the most innovative tech-led region in Europe.
We need a self-sustaining economic region, distinct from London, with access to land for housing and development, people and skills to allow Cambridge’s high-tech, high value-added sectors to expand, and for broader linked activity in manufacturing and services to have cost-effective locations for growth. That will never all happen south of Cambridge.
Identity and accountability
So I was convinced we had to join up with our neighbours in Norfolk and Suffolk, not to preclude partnerships with Essex and Hertfordshire, but as a means to deliver the specific infrastructure to unlock future growth by gaining devolved strategic powers.
It also became increasingly clear to me that this would also be right in terms of identity and accountability. People in Cambridge will say “I am from Cambridge” and locally there are equally strong attachments to Ely, Huntingdonshire, Cambridgeshire, Suffolk and Norfolk, but across all three counties people will say that they live in East Anglia. They will often be less than clear who leads the strategy for the region: district, city, county or central government?
We need to have strategic focus and accountability. We need to bring decisions back from Westminster to East Anglia; to make local decisions locally, but with a coherent, collective strategy that is accountable in East Anglia, not controlled by the Mayor of London or Whitehall; to bring new life to the East Anglian identity, with well over a thousand years of history; and most of all, to take for ourselves the power to shape our quality of life, our opportunities, our services, our homes and work.
In short, we need to take our future into our own hands. Devolution is an opportunity we must not miss.
Lord Lansley was Conservative MP for South Cambridgeshire, 1997-2015, and health secretary, 2010-12. This article first appeared on lgcplus.com