Plans to introduce a comprehensive devolution of power in healthcare should be introduced within a year to support the NHS’ Covid-19 recovery and reduce health inequalities, a report has said.
The report, by the Health Devolution Commission (HDC), a group made up of five former health ministers across the three main political parties, said the ‘far-reaching and profound’ impact Covid-19 has had on health and social care services means there is now a ‘compelling, burning deck of circumstances that requires an urgent and radical response’.
The Commission concluded that comprehensive health devolution has become ‘the most viable solution’ for delivering integrated NHS, social care and public health services, reducing health inequalities, re-building the economy and being better prepared for any future pandemic.
This would also be ‘the most effective way’ of addressing the social determinants of health outlined in the 2010 Marmot review, including poverty, poor housing, poor diet, poor environment, and job insecurity in local communities, it said.
‘Not consistent or comprehensive’
Health devolution is already in place in areas such as Greater Manchester and London, but the report said there has been no ‘consistent’ or ‘comprehensive’ understanding of what ‘good health devolution looks like, the benefits it brings or how it should be developed’.
Instead, it called for health devolution to be developed in all parts of England through a ‘comprehensive health devolution mandate’, which would be agreed among locally elected leaders.
This mandate should be agreed with central Government and include robust structures for independent scrutiny, the Commission said.
A new funding mechanism should also be established to support a ‘place-based approach to integrated service commissioning and delivery, and the creation of locally-led single NHS, social care and public health budgets’, it added.
‘Do something different’
Andy Burnham, Greater Manchester mayor, former health secretary and HDC co-chair, said: ‘Throughout this pandemic, we have seen the limitations of an overly-centralised approach to health delivery. As we look to build back from it, and particularly in those communities hardest hit, we need to do something different.’
He added: ‘Devolution of power over the NHS also opens up new possibilities of improving social care. We need to see health and social care as a single, integrated system and that is what health devolution in Greater Manchester allows us to do. We have been able to drive improvements in social care, which has seen the number of providers rated inadequate go from 37 in 2018 to five in 2019.’