'Whitehall cannot do all this from the centre' - Call for comprehensive devolution of healthcare

Plans for comprehensive health devolution across England should be developed within the next year in the face of worsening inequalities amid the coronavirus pandemic, a report has recommended.

Launch of the Health Devolution Commission. Photo: Health Devolution Commission

Democratically led local partnerships could help to create “healthy, resilient and prosperous communities”, the Health Devolution Commission said.

The group, made up of five former health ministers across the Conservative, Labour and Liberal Democrat parties, said there is a “compelling ‘burning deck’ of circumstances that requires an urgent and radical response”.

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It said the pandemic had had a disproportionate impact on economically disadvantaged and black, Asian and minority ethnic communities, that people with health conditions like cancer and dementia had been badly affected, and that NHS and social care services are “deeply divided” while the demand for care is increasing.

Andy Burham, mayor of Greater Manchester and co-chairman of the commission, said the pandemic had shown the “limitations of an overly centralised approach to health delivery”.

He said: “As we look to build back from it, and particularly in those communities hardest hit, we need to do something different.

“Health is built in homes, families and communities more than hospitals. But health policy in this country is still too focused on treatment rather than prevention.”

He said his role as mayor allows him to have a vision for health in Greater Manchester “because we can break out of the Whitehall silos and link health to housing, education and employment”.

He added: “This simple difference makes the argument for health devolution. And it is now the solution of our times as we begin to face up to the inequalities exposed by Covid-19.”

Among the commission’s recommendations are that local social care and public health services such as physical, mental and acute care in the NHS should be integrated.

It also calls for a “health in all policies” approach to other services like housing, employment, transport, education, the environment and economic development.

It says plans should be developed across England within 12 months “through a new comprehensive health devolution mandate agreed jointly with locally elected leaders that reflects local boundaries and organisational footprints”.

The report said close working relationships will be needed between clinical and civic leaders, as well as community involvement and parity of esteem between the public, private and voluntary sectors.

The report said that while health devolution is already under way in different ways in areas such as Greater Manchester, London, West Yorkshire, Harrogate and combined authority areas, there is no “common, consistent or comprehensive understanding” of what it should look like, its benefits or how it should be developed.

Sir Norman Lamb, former Liberal Democrat health minister and current commission co-chairman, said the Government faces a “straight choice” on how to deliver a reformed system.

He said: “The case for reform of social care is now overwhelming. We need a well-funded system but the time has also come for joining up the NHS and social care. This has now become the mainstream view.

“But the question confronting the Government is how to deliver this. The commission believes there is a straight choice: between greater centralisation of NHS and social care services or comprehensive health devolution with a single budget for the NHS and social care in each locality – an approach which the commission proposes. Whitehall cannot do all this from the centre.”

Alistair Burt, former Conservative minister for community and social care, said: “After long deliberation and years of experience, we are clear about the case for change, submit this report as a formal contribution to that debate, and call on the Government to meet its aims of building back healthy, resilient and prosperous communities through radical comprehensive health devolution.

“I very much hope that it will consider in depth its four recommendations including giving legislative support to comprehensive health devolution and establishing new mechanisms of accountability and scrutiny.”

Sally Warren, director of policy at the King’s Fund and chairwoman of the report’s launch event on Thursday, said the commission considered evidence from more than 30 key organisations and had more than six months of deliberations.

She said: “It is the first report since Covid-19 to be putting forward a viable model of comprehensive health devolution that would put the health and wellbeing of local communities at the heart of a locally led approach to services, delivering parity of esteem and integration between the NHS, social care and public health.”