Health Foundation, April 2016
- Focusing primarily on devolution in the NHS, the report considers the potential implications for health and care outcomes in England and how policy could best evolve.
- It draws on analysis of the Devolution Deals agreed to date, relevant literature, and international experience with a focus on four European decentralised health systems.
- Key points:
- There are three drivers behind recent interest in devolution in England: economic growth considerations; ‘Mancunian exceptionalism’; and the NHS Five year forward view.
- Exactly how the devolution of health care within England will work to improve health and care outcomes is yet to be articulated.
- Interest in devolution within England is highly undefined, especially compared to other recent processes of health decentralisation.
- There is no empirical evidence that decentralised health systems consistently outperform centralised ones. It is clear that decentralisation is an ongoing process rather than a fixed state.
- Devolution is being seen as a potential catalyst for change through galvanising local leadership, but could also be a distraction from the crucial focus on improving quality.
- Devolution Deals must be aligned with other initiatives seeking to achieve similar aims. There must be a clear vision, process and framework for the powers available for areas seeking a Devolution Deal, and significant investment in leadership capacity and capability across health care must be made, particularly at a local level.
- The potential benefits of health care decentralisation are not certain; local leaders and policymakers must proceed with caution.
