Exclusive: Stevens casts doubt over NHS devolution outside Manchester

In a wide ranging interview, the NHS England chief executive also said NHS and social care commissioning budgets could not be joined until there was a “viable” funding proposition for social care.

Asked how many areas would take on devolved health budgets in the next few years, Mr Stevens said: “Probably not many.”

He added that apart from Greater Manchester, the few devolution deals that did include health would not quickly bring about the full integration of health and social care.

“I’m not sure I would bracket Cornwall with Greater Manchester, to tell the truth,” he said. “I’m not saying it’s not going to happen but a lot of work has got to take place in Cornwall before it would be in a position to assume more responsibilities over and above those which they are grappling with.”

Some London boroughs would “make serious steps towards integration”, while the West Midlands may invest in mental health services to reduce the benefits bill, Mr Stevens said. He said these examples were short of the full joint health and social care commissioning being set up in Greater Manchester.

In September an NHS England board paper set out nine factors it would use to decide whether NHS budgets should be devolved to councils. These included a track record of collaboration; a clear vision; the support of local health organisations; demonstrable leadership capability; and a clear exit route in case of failure.

Mr Stevens said: “You’ve got to demonstrate you’ve got the capabilities to take responsibility for a broader swathe of public money. I don’t think those are unreasonable tests. We want them to be met in as many places as possible but we shouldn’t kid ourselves where they’re not [being met], that they are.”

He also pointed out that the Cities and Local Government Devolution Bill did not currently include a provision to change the accounting officer for the NHS budget where funding was devolved, despite the potential to transfer NHS functions to local authorities. He suggested that, if powers were to be transferred, “it needs to be clear that the accountable officer line has moved as well and then I would not be accountable to Parliament for the use of the resources”.

“I am certain nobody would make a move that didn’t have the active support of the NHS,” he added.

On integration, Mr Stevens said joining health and social care commissioning budgets could not happen without a better funding settlement for social care.

This comes after a spending review settlement in which the chancellor boasted of a real terms rise in social care spending by 2020, which he said would support a fully integrated NHS and social care system.

Mr Stevens said: “Until we have clarity and a viable social care funding proposition I see no way in the real world in which you could blend £100bn plus of NHS funding with, in effect, an open ended liability for local authority financing.”