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Call to devolve health services to city regions gets cross-party backing

Call to devolve health services to city regions gets cross-party backing

🕔25.Jul 2016

City regions should be able to negotiate health devolution deals directly with the Government and take control of funding for NHS services and social care, a leading thinktank has recommended.

Giving regions new powers and freedoms will lead to more integrated planning and delivery between health and social care because decision making locally will be better, according to Localis.

In a research paper Local Empowerment – how to achieve a sustainable health and care service Localis argues that greater financial control would allow local areas to radically rethink how funding flows through their local health and care system.

This, it is said, would create a completely different set of incentives to integrate services and the flexibility to direct more investment into preventative measures and non-hospital based services.

The study’s recommendations have attracted cross-party backing from senior politicians including Norman Lamb, a former Liberal Democrat Health Minister who is chairing the West Midlands Combined Authority’s mental health commission, and Stephen Dorrell, the former Tory Health Secretary who is the independent chair of a board that will drive plans to help local government and the NHS improve people’s health and financial efficiency in Birmingham and Solihull.

Mr Dorrell said:

By taking the opportunity to embed the NHS more closely in the full range of local public services, and harnessing the natural impatience of voters, the report sets out an agenda which provides a key response to the health policy challenges we face.

The report is also extremely timely. At a time when it seems that discussion about the implications of Brexit borders on an obsession, it argues that local leaders to step forward to fill the vacuum.

The message is clear. Civic leaders should not wait for permission; they should act now and seek forgiveness later – in the unlikely event that it proves necessary.

Mr Lamb said:

This report is a welcome contribution to the debate on devolution, setting out an ambitious liberal vision for the health and social care service.

The centralised structure of the NHS has too often stifled innovation, efficiency, and local accountability.

Even though most people now agree that decisions should be made as close as possible to the people they affect, we haven’t done enough to apply this principle to our most treasured public service.

Given the growing demands on health and care services, there is a powerful case for giving local areas more control over service design, health and care integration, and revenue-raising powers.

Localis is suggesting Clinical Commissioning Groups should be given five-year fixed budgets and balance them over the medium-term rather than annually and that local authorities should offer business rates discounts to companies that improve their workforce’s health and wellbeing.

The study also calls for combined authorities to be given powers to establish devolved health taxes.

Other recommendations include:

  • The local area’s departmental health budget should be fully devolved with local leaders accountable for its control and distribution.
  • Local areas should commit to full open book accounting between providers and commissioners.
  • Local areas should be increasingly exempt from certain national directives such as the Better Care Fund, wider NHS planning and performance targets.

The paper urges the Government and NHS England to run a national campaign to create a new integrated care workforce, looking beyond traditional job title boundaries.

London mayor Sadiq Khan is also supporting the Localis paper:

This report is further evidence that devolution is crucial for London, and all our cities and neighbourhoods, to take back control of their own destinies.

Providing NHS leaders with greater flexibility and ownership over their services will help them to better meet local demands and manage the health of their communities.

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