The Health Devolution Commission

The Health Devolution Commission is an independent cross-party and cross-sector body working to champion and support the successful implementation of devolved and integrated health and social care services across England.

The Commission believes that the lack of local integration of the disparate services within the NHS, and between the NHS and social care, public health and other public sector services is a major barrier to improving people’s health outcomes, improving the experience of care that people receive, reducing health inequalities and improving the public’s health. This lack of integration creates avoidable cost inefficiencies, as well as economic and social costs to the health and prosperity of local communities.

The development of statutory Integrated Care Systems is welcomed by the Commission. We are working directly to make this a success through collating, collaborating and sharing thought leadership and expert opinion on devolution and integration from a broad range of perspectives, providing examples of best practice and influencing government and NHSE guidance.

The Commission believes that the successful devolution and integration of health (physical and mental), social care and public health will enable frontline staff to better meet the needs of local people, families and communities; provide a better, seamless experience of care, improve the public health and economic wellbeing of local communities, reduce health inequalities and support the financial sustainability of local services. 

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Our current focus

Following the Commission’s report Levelling Up Health – prepared in response to the Government’s White Paper and profiled in an MJ article here – efforts were made to achieve a series of changes to the Health and Care Bill in the House of Commons and House of Lords, prompting this letter from Lord Argar.

The Health Devolution Commission has continued in 2022 to advocate for a devolved approach to healthcare delivery and accountability. Our agreed work programme looks to develop good practice on, and promote, best practice on certain key issues amongst Integrated Care Systems as they are statutorily established in July this year. Read our press release about the launch of our work in 2022.

After the first roundtable in April – a recording of which can be found here – a summary report was prepared and an article placed in MJ – Taking Integrated Care Systems to the Next Level. In advance of the second roundtable in June a background briefing was prepared which provides key information on the issues of Health Inequalities, Children and Young People, Mental Health and Learning Disabilities.

A recording of the June roundtable, starting with Professor Michael Marmot’s contribution, is here. The slides presented by the Shelford Group, The Association of Directors of Children’s Services, Barnardo’s, Mencap and the LGA are also available. See here for the MJ’s news article after the session and click here for the Secretariat’s report of proceedings including the twelve emerging recommendations for future Integrated Care System best practice.

Latest - A Twelve Point Plan for ICSs

Phil Hope & Steve Barwick – 04.07.22

 

Andy Burnham, Mayor of Greater Manchester and former Secretary of State for Health, chaired the  latest Health Devolution Commission roundtable which examined how Integrated Care Systems (ICSs) might best approach their new responsibilities for reducing population health inequalities and improving the health and wellbeing of children and young people.
It also shone a light on why ICSs should give parity to mental health services and provide support for people with learning disabilities. Twelve recommendations emerged from the excellent presentations and ensuing debate.
First, ICSs need to adopt a ‘Health in All Policies’ approach by to tackle the social determinants of ill-health. This is essential if there is to be a significant reduction in health inequalities and should be developed at every level – local, city, region, national and supra-national. The Commission also agreed that much more must be done nationally in the UK, underpinned by law, to reverse the last decade’s shocking decline in health equality if ICSs are to succeed in this goal.

 

Second, Foundation Trusts must recognise their role and impact as anchor institutions in local communities. ICSs in some instances may need to help ensure every hospital develops this anchor role. Once recognised FTs must then work in partnership with local government, the voluntary sector and local businesses to address health inequalities in their local populations as well as inequalities in access to health services.

 

Third, the goal of equality, as well as quality, should be embedded in ICS and organisational codes of governance. Evidence was presented showing how institutional resources are being shifted upstream towards prevention. The ‘bottom-up’ voice of communities and ‘top down’ action by system leaders should be combined to crack the challenge of improving the population’s health and reducing health inequalities.

Fourth, ICSs offer a chance to move beyond institutional and silo thinking, towards a whole system approach to deliver health improvement through a wide agenda for action including air quality, regeneration, transport, housing, employment and skills. However, the Commission recognised that delivery on this agenda will not be quick as the public’s expectation for the prioritisation of acute services – for example cancer treatments – will remain.

Fifth, it is simply wrong that children in severe mental health distress are now being put on a waiting list. ICSs must put children’s mental health at the top of their agenda ensuring that all partners – NHS, local government and the voluntary sector – act to reverse the current situation. It was noted that excellent recommendations for reform of children’s care services by Josh McAllister are in danger of being overwhelmed by the impact of the current mental ill-health epidemic.

Sixth, for ICSs to manage the landscape for children and young people – which includes education as well as the NHS, local government and the voluntary sector – will require joint action locally and a more joined up approach between DfE and DHSC. Effective data sharing is still not in place and there are no dedicated national funding streams for children’s health as there are for conditions such as cancer.

Seventh, care services for children and young people should not become over-medicalised but address the wider social, family, financial, educational and cultural factors influencing their growth and development. Schools must be fully engaged in the strategy and recognise their role as anchor institutions in local communities. And the voice of children and young people is essential if change is to be successful.

Eighth, every ICS should develop a children and young people’s policy framework based on a common set of design principles and containing clear indicators of success. Place-based partnerships should include informal support in the community as well statutory services for children. National cross-departmental leadership between health, social care and education is required to support local integration.

Ninth, ICSs should be committed to parity of esteem between physical and mental health services. They will have a critical role to play in improving people’s mental health, improving the services they rely on, reducing health inequalities and improving access to mental health services for marginalised groups in need.

Tenth, ICSs should develop a fully funded post-covid mental health recovery plan for their area supported by a robust workforce development strategy. Mental health services should be represented at every level in the ICS system with a full place on the ICS Board. And there should be a process to allow the voice for mental health service users to be heard at every level – the ICS system, place-based partnerships and neighbourhood PCNs.

Eleventh, ICSs should do more to ensure people with a learning disability can lead an active, full and healthy life. There are huge inequalities in health and life expectancy of people with a learning disability that ICSs should address as a priority. The ICB Board member for Learning Disabilities and Autism should use their position to pro-actively monitor and encourage progress.

Twelfth, ICSs should develop a learning disability action plan including driving up the numbers on the Learning Disability Register (a passport to other services and benefits). They should also seek to exceed their national target for Annual Health Checks and ensure GPs provide a Health Action Plan for all people with a learning disability.

In conclusion, ICSs offer a very real and unique opportunity for implementing the next chapter of reform in our health and social care system and one in which health inequalities are centre stage. There is genuine optimism ‘on the ground’ and strong support from NHS England and Improvement.

However, good institutional architecture and better relationships between NHS local government and other partners, will only go so far. Supportive central Government action, including stemming growing inequality and poverty, is crucial. Making inroads on health inequality will require not only local collaboration but also central Government action.

To read the full report of the roundtable click here.

For an invitation to the next roundtable which will consider Developing ICS Best Practice on the key issues of Workforce Development, Partnerships at Place, and System Regulation and at which the Minister for Integration, Gillian Keegan MP, is speaking please email [email protected]

Who we are

HEALTH DEVOLUTION COMMISSIONERS

  • Rt Hon Andy Burnham, Mayor of Greater Manchester and former Secretary of State for Health (Co-chair)
  • Rt Hon Sir Norman Lamb, former Minister for Community and Social Care (Co-chair)
  • Rt Hon Alistair Burt, former Minister for Community and Social Care
  • Rt Hon Stephen Dorrell, former Secretary of State for Health
  • Phil Hope, former Minister of State for Care Services
  • Cllr Isobel Seccombe, Leader Warwickshire County Council and Wellbeing Portfolio Holder, WMCA
  • Dr Linda Patterson, former Medical Director of CHI and Vice President of RCP
  • Peter Hay, former President ADASS
  • Nadra Ahmed, Executive Chair, National Care Association
  • Naomi Eisenstadt, Chair Northamptonshire ICB
  • Imelda Redmond, former Chair, HealthWatch
  • Suzi Leather, former Chair, Devon ICS
  • Cedi Frederick, Chair Designate, Kent and Medway Integrated Care Board

ADVISORY COMMISSIONERS

  • Cllr Rosemary Sexton, Independent Group Lead Member, LGA Community Wellbeing Committee
  • Sarah Walter, Assistant Director, ICS Network, NHS Confederation
  • Clive Grimshaw, Strategic Lead for Health and Social Care, London Councils
  • David Weaver and Steve Mulligan, respectively President and Four Nations Lead, BACP
  • Cathy Elliot and Rob Webster, respectively Chair and Chief Executive, West Yorkshire Health & Social Care Partnership
  • Sarah Price, Chief Officer, Greater Manchester Health & Social Care Partnership
  • Warren Heppolette, Executive Lead, Strategy & System Development, Greater Manchester Health & Social Care Partnership
  • Jackie O’Sullivan, Executive Director of Communications, Advocacy and Activism, Mencap
  • Ciara Lawrence, Engagement Lead, Mencap
  • Rukshana Kapasi, Director of Health, Barnado’s

Click here to find out more about the Health Devolution Commissioners.

 

If you are interested in supporting the work of the Health Devolution Commission then please get in contact via [email protected]