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Health devolution not appropriate in every area – MPs

Despite its great potential, health devolution “may not be needed” in all areas and some city-regions would be wrong to pursue it at the expense of other health and care initiatives, MPs have said.

In a report today, the Commons Communities and Local Government Committee found that health devolution has come at a particularly difficult time for the health and care system and its staff, with “significant structural change” recently and an “unprecedented level” of financial challenge.

Because of these uncertainties, the committee said it was concerned about the long-term consequences of formal health devolution and recommended that areas with similar and already fruitful health initiatives – such as joint working and pooled budgets – ignore it entirely.

The government should also gather evidence over an appropriate timescale, it said, on the impact of these health reforms.

Areas that do wish to pursue health devolution – about half of the 38 regions that submitted devo bids to the government last year – “must have clearly defined objectives for what they expect it to deliver”.

In these areas, the committee said it is still unclear how accountability will work in practice. They found care minister Alistair Burt MP’s explanation “confusing”.

The report says: “Considerable concern has been expressed about whether health services in areas with devolution deals would remain subject to national standards. Clause 19, inserted into the Devolution Bill in the House of Lords, confirms the continuation of NHS accountabilities and the regulatory responsibilities of the CQC, Monitor and others under devolved arrangements.

“In terms of regulation, we heard that regulatory bodies, such as Monitor and the NHS Trust Development Authority, would adapt to regulate the devolved area and make sure their powers covered the ‘wider footprint of the areas that will be commissioning and providing’.

“However, it would appear that their powers do not extend to regulating a local authority’s financial contribution to a pooled budget and it was not clear which body was in fact responsible for checking their financial position. There is also a lack of clarity about the audit and regulation of pooled budgets and, in particular, oversight of the sustainability of local authorities’ contributions.”

The Committee said it was left feeling that arrangements Burt described “were more aspirational than a thought-through and watertight system of financial regulation”.

Improving transparency and communication

But clearly articulating how health devolution will be governed so patients, residents and staff can understand was just one element of how the entire system must improve its transparency.

Another important measure it to ensure that, from now on, the public must be “engaged, consulted and communicated with” throughout the devolution process and once a deal is agreed.

“Public engagement is particularly important in the case of health devolution where the complexity of the systems in place make understanding the consequences of change more difficult in an area where the public’s response is likely to be more emotional,” the report said.

Rob Webster, the NHS Confederation’s chief executive, who also provided evidence to the committee’s inquiry, said today: “High quality, sustainable services can only be delivered by local organisations working together within a supportive national framework. Devolution is one of the ways that this will be delivered in some parts of England.

“We are glad this report recognises that devolution will not apply everywhere, and where it does it must be owned by citizens, patients and health organisations.

“The committee has also repeated our clear warning that devolution should not be seen as a silver bullet for solving wider financial challenges. If we do not address the question of financial sustainability across the whole of the health and care sector we risk making a national funding problem a local funding problem.”

Committee chair Clive Betts said MPs will return to this issue later to ensure local areas and the communities secretary are delivering on their ambitions.


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