‘Devolution’ – the transfer of power from a higher to a lower level of government – is high on the political agenda in England, and looks likely to remain so for the course of this parliament at least. While recent interest in devolution within England has not specifically focused on health care, eight local Devolution Deals that include aspects of health care have been agreed or announced in 2015 and the first part of 2016 alone.
Focusing primarily on devolution in the NHS, the report considers the potential implications for health and care outcomes in England and how policy could best evolve. It draws on analysis of the Devolution Deals agreed to date, relevant literature, and international experience with a focus on four European decentralised health systems.
- There are three drivers behind recent interest in devolution in England: economic growth considerations; ‘Mancunian exceptionalism’; and the NHS Five year forward view.
- Exactly how the devolution of health care within England will work to improve health and care outcomes is yet to be articulated.
- Interest in devolution within England is highly undefined, especially compared to other recent processes of health decentralisation.
- There is no empirical evidence that decentralised health systems consistently outperform centralised ones. It is clear that decentralisation is an ongoing process rather than a fixed state.
- Devolution is being seen as a potential catalyst for change through galvanising local leadership, but could also be a distraction from the crucial focus on improving quality.
- Devolution Deals must be aligned with other initiatives seeking to achieve similar aims. There must be a clear vision, process and framework for the powers available for areas seeking a Devolution Deal, and significant investment in leadership capacity and capability across health care must be made, particularly at a local level.
- The potential benefits of health care decentralisation are not certain; local leaders and policymakers must proceed with caution.