Local NHS control could be 'more delegation than devolution'

In a paper signed off at its board meeting this morning, NHS England said further bids for health devolution would need to have the support of local health organisations and “clarity of vision” about the benefits of devolution for the health and social care of local people.

Further criteria include “leadership capability and track record of collaboration between NHS bodies and local government” and a “demonstrable track record of collaboration and engagement with patients and local communities”, the paper said.

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So far two devolution deals, in Greater Manchester and Cornwall, include aspects of health and social care.

Analysis by HSJ’s sister title Local Government Chronicle of 27 of the 31 detailed devolution bids recently submitted to the government by English councils found 12 other areas are seeking greater control over health services (see box below). Suffolk wants devolved multi-year funding settlements for health and social care while the Heart of the South West Local Enterprise Partnership bid, which includes Devon, one of England’s most financially challenged health economies, wants the freedom to “develop local metrics and incentives” for health and social care.

However, the NHS England paper said principles to consider when determining decisions include an “overarching principle that all areas will remain part of the NHS”.

Richard Humphries, assistant director of policy at the King’s Fund, told LGC that the statement was “very significant” considering the question with devolution was “how to reconcile the ‘national’ in the National Health Service and the word ‘local’ in local government because they have different points of accountability”.

“That [statement] seems to me that what’s being proposed is more delegation than devolution,” he said.

The board paper, written by NHS England’s national commissioning strategy director Ian Dodge, assumed the Department of Health and NHS England would be involved in decisions about devolution and said its commissioning committee would consider and decide on individual cases. Its “preferred option” would be to take about 18 months from an expression of interest by a particular area to implementation of devolution arrangements.

Other areas that will be considered are whether a bid covers a “health geography” that supports devolved decision making, the impact on other populations, financial risk management, quality and continuity of care, and a “clear mitigation plan and exit route in the case of failure”.

NHS England’s proposals come ahead of the second reading of the Cities and Local Government Devolution Bill in the House of Commons next month. The board paper said NHS England’s principles, decision criteria and process will be refined as the bill develops.

Principles to be considered when determining future calls for devolution include ensuring all parties are “able to work together to shape the future of the local area”, decisions are made at the most appropriate level, and that there are accountability arrangements for the services and public expenditure being devolved. Others are a clear plan to support long term clinical and financial sustainability and a “simple” governance model that minimises bureaucracy and overheads.