Ministers, City Hall and the capital’s local councils have signed a new framework agreement which could see the eventual devolution of NHS services in London.
The government’s recent spending review set out the goal of local authorities providing integrated health and social care services by the end of the decade.
In London five pilot schemes, supported by the London Health Board which is chaired by Mayor Boris Johnson, will be conducted before the government makes a final decision on which, if any, health powers to devolve.
Chancellor of the Exchequer George Osborne said: “Today’s agreement is another crucial step in our devolution revolution and is the start of us handing over valuable healthcare power to local leaders in London.
“This deal means that not only will the people of London have more control over decisions that affect their lives, it will also lead to better, more joined up health care in the capital for Londoners.”
- Haringey will run a prevention pilot exploring the use of flexibilities in existing planning and licensing powers to develop new approaches to public health issues
- Barking & Dagenham, Havering and Redbridge will run a pilot to develop an Accountable Care Organisation, where primary and secondary care are more closely integrated and patient pathways are redesigned with a focus on intervening early and managing the chronically ill
- North Central London (Barnet, Camden, Enfield, Haringey, Islington) will run an estates pilot to test new approaches to collaboration on asset use
- Lewisham will run a pilot seeking to integrate physical and mental health services alongside social care
- Hackney will run a health and social care integration pilot, aiming for full integration of health and social care budgets and joint provision of services. This will also have a particular focus on prevention
Any final agreement to devolve more powers would be dependent on ministers being reassured that the move would not harm healthcare provision in areas outside London.
Today’s framework makes clear that “healthcare services in London would remain part of the NHS” and commits London’s councils and City Hall to “increasing value from unused and under-utilised” NHS buildings and reducing running costs within the system.
Jules Pipe, chair of London Councils which represents all local boroughs in the capital, said today’s deal “marks the culmination of much hard work between the boroughs, local clinicians in the CCGs, the NHS, Public Health England and the GLA.”
He added: “Through greater integration of our services we intend to deliver better outcomes for Londoners to support them in living healthier, independent lives. This agreement provides a strong joint framework for us to deliver that agenda together.”
Mr Johnson commented: “As we’ve shown through transport, policing and planning, devolution is already working in London and this agreement paves the way for a revolution in how health and social care are delivered across the capital.
“With our city’s population continuing to grow, it is essential that we have a health service better equipped to manage its own resources so that it can become even more responsive to the needs of Londoners.”
Commenting on today’s announcement, Liberal Democrat London Mayoral candidate Caroline Pidgeon said: “I have long supported devolving much of the health budgets in London but this announcement today misses one major opportunity.
“With the London Ambulance Service only just recently put into special measures, its performance having been rated ‘inadequate’ by government inspectors, George Osborne and Boris Johnson have missed an opportunity to bring the oversight of the Ambulance Service under the control of the Mayor and London’s government. Creating one ‘blue light’ emergency service for London must be a priority.”
Labour’s Sadiq Khan commented: “Giving London more power over our health services is absolutely crucial to improving the care that patients receive in the capital.
“It’s the only way we can ensure GP surgeries become more accessible, that our A&Es can cope with a winter crisis, and that older Londoners receive the dignity and care that they deserve.
“But the devil is in the detail. Manchester was promised control of health services years ago, but nothing has happened yet – we can’t afford to wait that long in London.
“And we must ensure that the fine print of any devolution proposal works for London, and that the proper management and financial structures are in place.”