- Devolution bill would allow NHS functions, assets and funding to be transferred to local government
- Experts warn of increasing variation in NHS offer across the country
- Devolved areas would remain accountable to regulators
- Health secretary would continue to have responsibility for NHS services
MPs will next week consider “radical” plans to give ministers wide ranging new powers to transfer NHS functions, funding and assets to councils.
This comes despite experts warning this could lead to significant variations in the service offered in different parts of England.
The Cities and Local Government Devolution Bill reaches the committee stage in the House of Commons on Tuesday.
The bill includes a clause specifically about the NHS, which if enacted would enable ministers to transfer NHS functions to combined authorities made up of two or more councils or “other public bodies”.
Transferring functions from an NHS body to local government would be a significant step beyond the joint decision making and budget pooling being established under the Greater Manchester devolution deal. At its most extreme, all responsibilities of a clinical commissioning group could be taken on by a combined authority under the proposals.
The bill also contains provisions for ministers to order property, rights and liabilities to be transferred from any public authority – including NHS England, trusts or foundation trusts – to a combined authority.
The combined authority would remain answerable to regulators such as NHS Improvement and the Care Quality Commission, and regulatory functions could not be transferred.
An amendment approved by the House of Lords in the summer said councils should still adhere to national NHS service standards and accountability obligations. However, this was weakened last month by a government amendment that stated the combined authority should only “have regard” to national standards. A Department for Communities and Local Government spokeswoman said this change brings the bill in line with existing NHS legislation.
Capsticks partner Sharon Lamb said: “The bill creates a radical framework for the potential transfer of NHS functions to local government.
“In theory, it allows for complete integration of health and local government functions and funding. But the real question is the extent and timing of its use. There are still unanswered questions about how the transfers would work in practice, especially around funding.”
Helen McKenna, senior policy adviser at The King’s Fund, told HSJ: “If the order making powers were used in the way set out in the bill the effects could potentially be far reaching for the NHS.
“The health secretary would retain ultimate accountability to Parliament… and along with his continued duty to have regard to the NHS constitution and national regulatory powers remaining the same, this should provide some protection for the NHS. But because we don’t have a fully defined offer for the health service, and not everything the NHS does is set out either in the constitution or the legislation underpinning it, it is possible that you would see more variation in the NHS than currently exists.”
Ms McKenna said she believed the Department of Health would need to use the powers described in the bill to enable the new Greater Manchester combined authority to take over specialised commissioning, as existing powers are not sufficient.
Lord Hunt, Labour’s health spokesman in the Lords, said that the safeguards would not allow the abolition of the NHS in devolved areas, but bill still had “enormous implications for the NHS”.
“The unknown unknown is, is this also a slippery slope to transferring funding responsibility to local government?” he added.
Bill Morgan, partner at Incisive Health, said “on paper, they’re giving themselves a very significant power”, but it would be unlikely that the legislation would be used in this way if enacted. If a minister attempted to transfer significant NHS functions or assets to local government via secondary legislation it would trigger a “massive row” in Parliament, he added.
“There are already other even more powerful mechanisms in place that ministers could use to ride roughshod over NHS legislation,” he said. “There is a power under the Civil Contingencies Act that allows the government to change virtually any piece of legislation ever passed.”