Health Policy

Health devolution deals should take 18 months to implement – NHS England

NHS England wants health devolution deals to take about 18 months from expression of interest to full implementation, along the same lines of Greater Manchester. 

The process would include the submission of a clear outline business case, plus a period of shadow running of the new devolved functions. The formal arrangements would also include the joint signing of a memorandum of understanding between the parties. 

A paper to be presented to NHS England’s board this week notes that in particularly “large or complex geographies”, piloting in a selected sector of the area concerned “may be required”. 

Ian Dodge, NHS England’s national director for commissioning strategy, said decisions on individual devolution cases will be made by the Commissioning Committee with the “authority of the board”. 

The full decision criteria and process will be further shaped by the Devolution Bill, currently making its way through Parliament. 

Based on the assumption that the Department of Health and NHS England are involved in decisions about requests for devolution, likely criteria include: 

1. Clarity of vision about the benefits devolution will bring to the health and social care of local people, and the plan for delivery of these and wider benefits including a clear articulation of what specific additional functions and responsibilities are being requested;
2. A ‘health geography’ that supports devolved decision-making, being largely a self-sufficient community with a matching corporate infrastructure rather than relying on other areas of the country for delivery of devolved functions;
3. Quality and continuity of care, particularly linked to the safe transfer of responsibilities and emergency planning, preparedness and resilience arrangements;
4. Impact on other populations, including appropriate safeguards for users of local services from outside the relevant geography;
5. Financial risk management, including mitigation actions by, and residual risk to, NHS England;
6. Support of local health organisations, and local government (including political leadership) so that there is a solid basis of co-operation on which to build shared decision-making and robust, devolved arrangements;
7. Demonstrable leadership capability and track record of collaboration between NHS bodies and local government, implementing transformation and securing consistent
8. Demonstrable track record of collaboration and engagement with patients and local communities, including evidence of sufficient consultation on, and broad support for, the devolution proposals;
9. Clear mitigation plan and exit route in the case of failure. 

The Devolution Bill completed its third reading in the House of Lords in July 2015, where the devolution of NHS powers to Greater Manchester came under significant fire. An amendment was successfully tabled by Labour peer Lord Warner with the intention of providing greater clarity about the continuation of NHS accountabilities and regulatory responsibilities under devolved arrangements. The Bill is due to go to the House of Commons in the autumn.

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