Legislation to devolve powers to cities and local government must not be overly prescriptive or reliant on using the Greater Manchester model as a blueprint for devolution arrangements, a parliamentary inquiry has been told.
A bill or regulations that are too prescriptive could risk disenfranchising local leaders by enforcing one set of arrangements on all localities seeking devolved powers, the NHS Confederation has warned.
In evidence submitted to the Communities and Local Government Committee’s inquiry into the Devolution Bill, the organisation said local leaders need the freedom to create the best type of partnership arrangements for their situations locally.
In some cases this will mean formal arrangements of the kind the Devolution Bill seeks to facilitate. In others, using existing freedoms and mechanisms or developing completely new models may be a better fit, the submission argues.
In this vain, the Confederation has highlighted that many local areas have already begun integrating decision-making around how to best spend increasingly limited local resources. Many are seeking devolved powers or increasingly working with local partners.
No ‘silver bullet’
Informed by feedback and engagement with NHS Confederation members, the submission also cautions MPs against viewing devolution as a ‘silver bullet’ to the financial challenges facing health or social care.
Although the Devolution Bill is seen by members as “an important legislative framework”, “devolution of health and care will not necessarily improve financial sustainability unless funding issues across the system are addressed in the forthcoming Spending Review.
“Until this happens, our members fear that all devolution may be achieving is making a national funding problem a local funding problem.”
Implications for health and social care
The committee is examining considering how the Devolution Bill, currently making its way through Parliament, will build on local accountability. Clause six has potentially the greatest implication for NHS organisations. It seeks to allow local authorities to take on or share the functions of other public authorities, including NHS bodies.
The Confederation’s evidence to the inquiry outlines a number of implications of devolution and areas requiring further consideration.
This includes possible issues relating to regulation and accountability, the potential for local variations in access to NHS-funded services, the cross-border impact of devolved decisions and issues affecting the workforce.
The organisation has also strongly recommended that a key focus for local partnerships should be the role of the NHS in driving jobs and growth.
“By becoming a valued local investment partner, the NHS can improve its service to the community, have a much greater say in developed strategic discussions and secure long-term additional funding into the health and care system.”