The government’s proposals to expand devolution in England is an ‘opportunity’ to build healthier communities, according to the Health Foundation.
The proposals, outlined in the English devolution white paper which was published this week, set out the government’s plan to ‘give communities stronger tools to shape the future of their local areas’.
The plan will introduce new ‘strategic authorities’ across the country, which will feature a number of councils working together. Many places already have combined authorities that serve this role, the white paper said. But it’s aim is for ‘universal coverage’ across England, preferably with elected mayors, and to have ‘devolution as default’ rather than ad hoc as it is now.
These authorities will have a ‘new bespoke duty’ in relation to health improvement and health inequalities.
While not mandated, mayors will also have a role to play in at integrated care system (ICS) level, with the expectation that they will sit as members of integrated care partnerships, be involved in appointing chairs of ICBs and setting their priorities.
There is also a longer-term ambition that public service boundaries will be aligned, which could have implications for ICS areas.
Responding to the white paper, assistant director of healthy lives at the Health Foundation, Katherine Merrifield, said: ‘Devolving more power to local areas is an opportunity to build healthier, thriving communities.
‘Combined authorities and local councils hold many of the levers to take action on the building blocks of health, such as people’s access to good quality work, transport and housing.
‘We are therefore pleased to see the introduction of a new duty in relation to health improvement and health inequalities and the commitment to give the newly named strategic authorities the powers and levers they need to deliver on the health inequalities element of the health mission. We are also glad to see a focus on making prevention the default setting and a new outcomes framework to improve accountability.’
However, she added that the ‘devil will be in the detail’ and that the government will need to deliver quickly on the commitment to fairer funding and work through the new powers and levers to improve health.
‘Crucially, the government needs to work in a different, more joined-up way to deliver on the commitment for Whitehall to think “devolution by default”,’ she added.
‘In particular, the government must provide sustainable local funding that meets the current population’s needs, ensures financial stability for councils to invest in improving health, and restores the public health grant to its 2015/16 value. Additionally, with 60% of local authority funding spent on children’s and adult social care, the lack of a sustainable funding solution for social care must be addressed and done so urgently.’
Deputy Prime Minister and housing, communities and local government secretary, Angela Rayner said: ’Devolution is about delivering fundamental change at every level. It’s about giving local leaders the tools – and the trust – they need to forge their areas’ futures.
‘It’s about raising living standards, improving public services and building the homes we so desperately need – all key aspects of our Plan for Change. It cuts across every aspect of government.’
It comes as a report found that partnering with community groups would be key to tackling health inequalities.
The CQC is also to launch a health inequalities framework for ICSs in February 2025, following testing in four areas this year.
