Essential insight into England’s biggest health economy.

It’s finally here!

It’s heavily caveated – but the London devolution memorandum of understanding has been released.

Before getting to the good news, it’s worth stressing again, it’s very conditional and it’s an MoU, which doesn’t legally commit the parties to anything.

But there are effectual things in the 28 page document and scope for solidifying some of the more aspirational bits.

Delegating London’s share of the transformation funding to the London Health and Care Strategic Partnership Board could be a big step.

I say “could”, because these significant sums “will be exercised by way of internal delegations within NHS England to representatives who will make decisions within the forum of that board”.

Which really is just a commitment that NHS England will listen to the board in making its decisions.

NHS England has also committed to delegating “primary medical services commissioning to the local level, subject to CCG agreement”.

This is confusing as NHS England has already delegated some primary care commissioning powers to London CCGs. The conflict of interest issues this could bring up are not mentioned either.

The national commissioning board would only promise to “explore” delegation of specialised and “highly specialised” commissioning.

Although it suggests this could happen as early as April, subject to suitably firm plans, governance arrangements and NHS England’s “standard readiness assessment”.

This suggests the centre has some services in mind already that might move a little faster here and others may be a lot longer in coming.

The document steams ahead boldly into a national policy issue: does London get to keep the proceeds of land it sells into its overheated property market?

Managers from other parts of the country point out they can’t finance hospital rebuilds this way because of lower property prices and there had been noises made about the capital sharing this wealth.

The MoU says: “National partners agree in principle agree in principle to NHS trusts and foundation trusts in London retaining capital receipts, on the basis that the London Estates Board will identify how to re-invest those receipts to support agreed system-wide health priorities.”

So, bad luck rest of the country, London keeps that property boom money. Bad luck non-foundation trusts that thought they could use their capital receipts just for their own plans.

Bad luck for any planners who thought they might have a say on how FTs spent their capital receipts. FTs can, and always have been allowed to, keep their capital receipts.

We’ve seen evidence of this at the Royal Brompton and Harefield FT, as it moves towards selling its Chelsea estate and moving in with St Thomas’ across the Thames.

How much will get for its inner south west London acreage? Enough to cover the estimated £800m rebuild in SE1.

The heart and lung specialist trust’s plans are at an early stage and the move could take up to a decade to complete – but fundamentally, control of the proceeds of FT land sales rests with FTs.

In London at least, this looks to be the foundation trust movement’s most significant legacy.