The Devolution Bill allows Secretaries of State to remove duties and powers from public bodies, including NHS trusts and commissioners, and transfer them to local authorities. It lays the ground for more involvement of elected councillors and mayors in the health service. We urge MPs to investigate a series of important points about how this might work and the issues it might raise.
The Bill creates a two-track process for shifting NHS powers to local leaders. One is a delegation process as used in Manchester. The other is a more powerful mechanism that could transfer control of national standards, and the powers held by bodies like NICE and the NHS Trust Development Authority.
We encourage MPs to look at why this is, and what it means for issues such as variation in care, and the use of NHS funding. There are good arguments for different goals and priorities in different areas, but have the risks been looked at? If health service funding is to be shared into wider local or regional budgets, will key pledges on health funding become meaningless?
Accountability is also an important issue. Could devolution lead to confusing, unhelpful clashes between different levels of government over who is responsible for difficult and unpopular decisions?
We also suggest that MPs should look at the possibility that this Bill could have a centralising effect, moving powers upwards from local authorities and commissioning groups to larger regional authorities. How can policymakers combine this with keeping the best aspects of local and clinical engagement?
Nuffield Trust (2015) Cities & Local Government Devolution Bill: Report Stage.