Combined authorities could ‘jointly’ hold NHS powers, instead of them being removed from government or health service bodies entirely, under government devolution plans, HSJ has learned.

  • Devolution bill will specifically reference transferring NHS powers
  • Will allow devolved authorities to hold responsibility “jointly” with others
  • Labour peers seek “clear” accountability

Ministers plan to lay an amendment next week which will specify this option. It will also create the first explicit mention of NHS functions in the Cities and Local Government Devolution Bill.

In Lords committee debates on the bill in recent weeks, peers have pressed the government on accountability for NHS functions under new arrangements, both in the bill and in existing proposals for Greater Manchester devolution.

A letter from local government minister Baroness Williams to peers this week, seen by HSJ, explains several planned government amendments. It states: “This amendment gives a power to attach conditions or limitation on a transfer of functions from a public authority to a combined authority.

“The purpose is to have the ability to impose current statutory obligations held by the secretary of state for health, NHS England or [clinical commissioning groups] on a combined authority or local council alongside a transfer of functions, thereby ensuring continuation of current NHS accountabilities and standards.

Lord Hunt

The amendments ‘do not make clear where accountability lies if NHS powers are transferred’, Lord Hunt said

“These amendments make it clear on the face of the bill that a function can be exercisable by the combined authority and public authority jointly. This gives the option that where a function is devolved, the authorities can be obliged to share the functions together as a matter of assurance to the public user of the service.”

Lord Hunt, Labour leader in the Lords, told HSJ: “We don’t think this goes anywhere near far enough because it doesn’t lay down a process on the bill by which it is clear where accountability lies if NHS powers are to be transferred to a combined authority.

“We are still worried about the fact that the powers of regulators like [the Care Quality Commission] and Monitor could also be transferred to a combined authority. We think that ministers’ powers to agree to such a transfer are too great, and there needs to be extra parliamentary scrutiny using the super affirmative procedure to ensure that a transfer of powers is properly considered.”

Labour peers will move amendments next week - designed to press the government to clarify its position - which would ensure an authority taking on NHS responsibilities has a governing body and a chief accounting officer responsible for them. The amendments would also require ministers to set a term of at least five years for each devolution, within which the government would not be able to intervene, except when “after due warning, a consistent inability to meet their population’s health needs or to do so within the agreed funding provisions made available to the authority or other designated body”.

Another amendment to be proposed by government next week would allow functions to be moved to single local authorities, as well as combined authorities. Baroness Williams’ letter says this would allow for devolution to single authority areas, and references Cornwall which, as HSJ and our sister title Local Government Chronicle revealed last week, is set for devolved powers and to integrate health and care commissioning. The letter says the move “ensures that all parts of England are on a level playing field for negotiating a devolution deals with the government”.