London devo bid targets more control over primary care

HSJ understands the plans could include a proposal to give full commissioning responsibility for primary care to clinical commissioning groups and local authorities if boroughs agree to pool health and social care budgets.

On a wider level, if groups of CCGs and boroughs agree new governance arrangements, in return they would be given the ability to change the tariff system to encourage a shift of patients away from hospital. 

HSJ’s sister title Local Government Chronicle has reported that leaders in London would resist any government attempts to fix multi-borough arrangements in return for devolved powers. 

Bexley London Borough Council leader Teresa O’Neill, who is London Councils’ executive member for health, told LGC it “doesn’t make sense” to force councils to work together in fixed partnerships, especially outer London boroughs that might want to work with local authorities outside the capital.

Cllr O’Neill said health and wellbeing boards would be best placed to lead this work, while conceding there is “wide variation” among HWBs. 

She added: “We’ve got the structure as health and wellbeing boards are already established, and although there is a wide variation in what people are doing there is a responsibility and capability there which can be built on.” 

The plans build on Lord Darzi’s London Health Commission recommendations, which last year called for more rigorous standards to be applied across primary care and penalties to encourage trusts to sell unused parts of their estate.

Under the proposals, health and social care budgets would be pooled at a borough level and a London-wide body would have control of a “cash support regime” to take over the provision of support to NHS providers with deficits from the Department of Health. 

A note in Imperial College Healthcare Trust’s July board papers said: “NHS England is working with the mayor of London and borough leaders to explore proposals to redesign London’s £93bn public services, which would include the devolution of health and social care responsibility to London boroughs… London councils, the [Greater London Authority] and London CCGs are continuing to explore the potential benefits of devolution and discussions with providers of healthcare in London will be crucial.” 

A London Councils spokeswoman said: “We are working closely with NHS England, CCGs, [Public Health England] and the GLA to reform and improve health and care services in the capital. This involves a wide range of work, building on the London Health Commission and experiences of the better care fund, and including consideration of what is needed from the [government’s autumn spending review] to support and enable us to improve the health and wellbeing of Londoners.”

An NHS England spokeswoman said: “Within the capital, CCGs and NHS England are working closely with local government partners to consider how best to advance the integration of care. That is likely to take very different form and shape in different parts of London and as compared with Greater Manchester. The NHS England board will consider at its public meeting later in September a set of principles, decision criteria, and processes for assessing any devolution plans, and these will inform our further work.”