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. We urge MPs to investigate a series of important points about how this might work and the issues it might raise.
It is not clear exactly which NHS powers it will be possible to devolve under the Bill. This needs to be closely investigated so that we can understand the implications for issues such as variation in standards of care, and the use of NHS funding. 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) Parliamentary briefing: Cities and Local Government Devolution Bill, 2nd Reading.