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Who is health devolution for?

The general consensus in local government is that health localism is a force for good. But have we taken a moment to listen to the voices of the people outside town halls? PSE reports.

Simon Stevens is one of the few national health leaders who spent a chunk of his career working as a councillor. Perhaps due to his days at the London Borough of Lambeth, where he represented a number of housing estates in Brixton, he now feels personally as well as professionally attuned to the contributions local government brings to healthcare. Just as the N in NHS stands for ‘national’, Stevens believes it doubles-up as ‘neighbourhood’ – or, in Whitehall jargon, ‘integrated and place-based decision-making’.

But despite the need for unity, the NHS England boss argues we’re already “beyond happy talk”. While this doesn’t equate to “talking ourselves into depression”, it does mean that under the financially restrained situation we find ourselves in, the only solution is for health bodies and local authorities to engage in what Stevens calls “practical talk”.

Local authority leaders seem to be in agreement. Speaking as part of a panel on health localism at Confed17, Cllr Linda Thomas, deputy leader of Bolton Council and vice-chair of the LGA’s Community Wellbeing Board, said local government is built on consensus.

“We’ve been consistently amongst champions of local place-based solutions, and that’s why we’ve been calling for local freedoms and flexibility,” she said, underlining the importance of shared cross-sector leadership to make use of the devolved powersin GM. “There has to be a shared vision and narrative on how devolution will help you.”

In Greater Manchester, for example, Cllr Thomas and the rest of the team have confirmed the importance of rich data intelligence, efficient resource deployment and shared performance targets, all of which rely on communication between the NHS and the region’s 10 councils. “We [councils] need to be there at the start of decisions – you can’t just bring us in as an afterthought once you’ve actually made the decisions,” she emphasised.

Also at the panel, Welsh health secretary Vaughan Gething AM said he has witnessed difficulties in his country where people try to deliver change without bringing along every part of the health and care spectrum, including its users. “You need trusts and clinicians to help you engage the public,” he continued. “It needs to be an active and an honest conversation.”

But are we doing enough to amplify the voices of the people in order to attract support for health localism? Louise Park, associate director of health at Ipsos MORI, argues otherwise. At the panel, she reflected on a 2015 survey from her organisation which found that while there is support for the concept of devolution, awareness levels are quite abysmal.

“You have about three-quarters of the English population who don’t know or have never heard the term devolution, or say they know very little about it and can’t describe what it actually involves,” she explained.

“There’s also something about there not being universal support for the concept of devolution depending on certain policy areas. Health and social care is interesting in that respect, because it’s an area where the public are not as convinced that local decision-making makes as much sense as it would do for subject matters like transport or housing. You have about 44% of the population saying those decisions should be made nationally versus 38% saying locally. When you think about housing, it’s 17% [against devolution].”

As Stevens said at the LGA Conference this year, we must recognise that some health devolution plans – potential hospital closures, for example – will face resistance from local councillors. But if the public aren’t briefed about these changes and given the opportunity to decide for themselves, it’s unlikely localism will amount to anything beyond more of the same: a top-down reconfiguration done to people, not with them.