Financially challenged Devon makes devolution bid

Local councils and CCGs in Devon and Somerset, calling themselves the “Heart of the South West”, have applied to the government for five year devolved budgets for health, care and public health, as well as powers and budgets related to skills, education and employment.

Northern, Eastern and Western Devon CCG – which is forecasting a cumulative deficit of £78.9m by the end of 2015-16 – Somerset CCG and South Devon and Torbay CCG are all parties in the bid.

The bid asks for devolution of “five year place based budgets” for health, care and public health. This would include devolved commissioning of primary and “associated specialist care services including mental health”.

The devolution partners also want “flexibility in regulation and budgeting” including freedom to pool resources, a greater focus on public health, capitation based payments and support to address skills shortages.

In return they promise to build on the Five Year Forward View by delivering a “whole system” approach to health and care.

The bid says the region could, given its ageing demographic profile, become a “national demonstrator of effective health and care integration”.

According to the partners’ prospectus, the devolution partners would like to sign a formal deal with the government in the first half of this year.

However, NHS England’s criteria for supporting devolution requests, which includes “financial risk management”, could be a hurdle to the bid.

Devon’s forecast a cumulative deficit is the largest CCG deficit in the country. The CCG, which is the biggest in England, is subject to NHS England “directions” and responsible for a health economy that was placed in the “success regime” last June.

In an interview with HSJ in December, NHS England chief executive Simon Stevens said neighbouring Cornwall would need “a lot of work” before the county would be able to assume more responsibilities.

Shortly after the interview, Kernow CCG was placed in NHS England directions after it emerged it was heading for a year-end deficit of £14m, against an initially forecast surplus of £0.5m.