Devolution of responsibility and budgets to local areas has emerged as one of the new government’s defining policy agendas.
This follows the ‘Devo Manc’ initiative that will see substantial responsibilities – including for health and social care – devolved to a new mayor and combined authority for the Greater Manchester area. In the July Budget, the Chancellor indicated that steps are already being taken to agree a number of other devolution deals. The government is also currently taking a Bill through parliament to provide a legal framework for devolution.
These developments have been greeted with cautious optimism. They promise a range of benefits including the opportunity to integrate commissioning and provision of health services, and services across health and social care. However, significant questions remain about the implications of devolution for the NHS given its national characteristics and tensions between central control and local decision-making.
- Devolution deals
In the July Budget the Chancellor outlined some of the next steps for devolving powers and budgets to city regions and towns. The Chancellor indicated that the government is already working towards devolution deals in several areas including Sheffield, Liverpool and Cornwall, which may involve establishing an elected mayor in each area to oversee the new powers. The Budget suggests that the government is willing to receive further devolution proposals, where devolution could be completed before the Spending Review (due November 2015). This has prompted interest from a number of areas.
The Budget also set out the next stage of devolution in Greater Manchester. This follows an agreement made under the previous government to devolve a range of new powers and responsibilities to Greater Manchester, and to establish an elected city-wide mayor. In February 2015 a memorandum of understanding was signed by the Association of Greater Manchester Authorities (representing 10 local authorities), 12 clinical commissioning groups and NHS England. This provided for the devolution of all health and social care responsibilities to Greater Manchester, bringing together budgets worth approximately £6 billion in 2015/16 and establishing arrangements for more integrated planning and commissioning.
The Budget indicated that, subject to legislation, Greater Manchester will receive a number of additional responsibilities. These include placing responsibility for Fire Services under the control of the new directly elected mayor, and establishing a Greater Manchester Land Commission.
- Cities and Local Government Devolution Bill
The Cities and Local Government Devolution Bill, which was included in the Queen’s Speech in May, is currently progressing through parliament. The Bill, first introduced in the House of Lords, is designed to allow the election of mayors in combined local authorities and the devolution of responsibility and accountability in a range of areas, including housing, transport and planning.
The Bill did not originally include any health-related provisions. However, during its passage through the Lords, there was some debate about the implications of devolving NHS responsibilities and, in particular, how to uphold national standards and accountabilities in a devolved system.
In response to the concerns raised, government amendments were passed to make it clear that the functions of regulators such as Monitor and the Care Quality Commission cannot be devolved, and to enable statutory duties currently held by the Secretary of State for Health, NHS England and clinical commissioning groups to be transferred as part of a devolution deal. However, this was not enough to satisfy the concerns of some peers and an opposition amendment was passed to provide stronger safeguards in this area and to extend the exemption on devolving the function of regulators to a wider range of bodies. The government will decide whether to reverse this amendment when the Bill goes to the House of Commons in the autumn.