Councils and NHS services look set to pilot new shared approaches to health and social care as a first step towards devolving more power over spending in London.

The end result is likely to be London councils and health commissioners joining forces in groups to plan service and pool budgets, rather than attempt to share resources across the capital, Teresa O’Neill, vice chair of London Councils and executive member for health, told HSJ’s sister title Local Government Chronicle.

City Hall London

Source: Maciek Lulko

A ‘direct replica’ of devo Manc is not seen as appropriate for London

Her comments come after NHS England chief executive Simon Stevens suggested plans for councils to integrate health and social care spending could not go as far as devolution proposals in Greater Manchester, which involve pooling a £6bn health and social care budget.

Mr Stevens said in a board meeting last week this was the conclusion from talks with Anne Rainsberry, NHS England regional director for London, and local government partners.

He said: “Anne Rainsberry and I have been in discussion with London Councils, the Greater London Authority and mayor about possible next steps on the integration agenda in London, recognising that for many reasons this should not take the same form as proposed in Greater Manchester.”

In Manchester, NHS commissioners, providers and local councils have agreed to pool health and social care budgets under a groundbreaking memorandum of understanding.

The London devolution plan, which was agreed by the mayor and borough leaders this summer, suggests health and social care budgets could be pooled at borough level, while plans for transformation of services and the use of NHS assets would be developed at a “sub-regional” level.

Ms O’Neill, leader of Bexley London Borough Council, said one approach would be to embark on a pilot or series of pilots – something NHS England appears to support.

“London is about five times as big as Manchester so it wouldn’t be a direct replica,” she said.

“What Simon was suggesting was you might look for pilots in London so if a region or groupings of boroughs and health partners was ready to start looking to get together in that sort of formal structure Manchester’s got then he would be interested in that.”

The pilot could involve a group of partners commissioning a wide range of services together or testing the approach for a particular service, she added.

In the meantime, Ms O’Neill said many local authority and health partners were already working closely together and “the next step would be to see if we can get groupings together”.

She said these groupings would come together “organically” with loose arrangements already in existence in some parts of the capital.

 “I don’t think it will necessarily be that everyone will do it at the same time but I don’t think it’s that far off,” she added.

She said the goal was to ensure more seamless services with improved continuity of care.

“The good thing is people, including the health service, are now talking about prevention. They’re not just talking about older people and hospital discharges, it’s very much across the board so children’s services come into it and everything. The whole picture has expanded out and we’re really looking at a whole system change.”

A spokesman for the Greater London Authority confirmed Boris Johnson was in discussions with NHS England and London Councils about the best way of delivering health and social care in the capital.

He added: “Due to its size and greater number of boroughs, what form this might take would almost certainly need to be different to what has happened in Manchester.”

NHS England said it was still looking at the plans but confirmed these would need to take account of the size of London and its population.