17 August 2020

The Commission’s final report – Building Back Health and Prosperity – was launched in August.

To read the full report, please click here.

To read the summary report, please click here.

It was picked up by a range of media outlets including the GuardianYorkshire PostMJ and LGC but the real value of Building Back Health and Prosperity will be whether it informs discussions in Parliament and Whitehall regarding the future of NHS and social care services which are bound to intensify in September and thereafter. We sincerely hope so.


Five former health Ministers, from all three main parties and including two previous Secretaries of State, Andy Burnham and Stephen Dorrell, have joined forces with think tanks, trade unions and charities to call for a comprehensive health devolution approach to the NHS and social care.

The Covid-19 pandemic has changed the world we live in and brought to the fore the devastating consequences of existing health inequalities and the urgent need to reform social care. 

While the work of the Devolution Commission started pre-pandemic, its findings take into account how coronavirus has affected every child, adult, family and community in our country with the biggest impact on the most economically disadvantaged and those from Black, Asian and Minority Ethnic communities. It has put the severest pressure on our NHS, social care and public health services exposing in the starkest terms the divide – the lack of parity – between them. It has touched upon every aspect of lives and has had a catastrophic effect on our economy and jobs that will be with us for years to come.

Proposing a radical new way forward for England’s NHS and social care services Commission co-chair Andy Burnham, Mayor of Greater Manchester and a former Health Secretary, speaking at the launch said:

“Throughout this pandemic, we have seen the limitations of an overly-centralised approach to health delivery. As we look to build back from it, and particularly in those communities hardest hit, we need to do something different.

“Health is built in homes, families and communities more than hospitals. But health policy in this country is still too focused on treatment rather than prevention. As Secretary of State for Health, it was possible for me to have a vision for the delivery of health services. As Mayor of Greater Manchester, I am able to have a vision for people’s health because we can break out of the Whitehall silos and link health to housing, education and employment. This simple difference makes the argument for health devolution. And it is now the solution of our times as we begin to face up to the inequalities exposed by Covid-19.

“Devolution of power over the NHS also opens up new possibilities of improving social care. We need to see health and social care as a single, integrated system and that is what health devolution in Greater Manchester allows us to do. We have been able to drive improvements in social care which has seen the number of providers rated inadequate go from 37 in 2018 to 5 in 2019. 

“After years of failure to ‘integrate’ NHS and social care the Commission proposes comprehensive health devolution which incorporates national entitlements but embeds the delivery of a single NHS, social care and public health service within broader, powerful, democratically led local partnerships.  If adopted, this approach would not only build back health and prosperity in every community but also better prepare us for any future wave of the pandemic.” 

Rt Hon Sir Norman Lamb, Commission co-chair and former Minister for Community and Social Care, said

“The case for reform of social care is now overwhelming. We need a well funded system but the time has also come for joining up the NHS and social care. This has now become the mainstream view. But the question confronting the Government is how to deliver this. The Commission believes there is a straight choice: between greater centralisation of NHS and social care services or comprehensive health devolution with a single budget for the NHS and social care in each locality – an approach which the Commission proposes. Whitehall cannot do all this from the centre”

The Rt Hon Stephen Dorrell, former Secretary of State for Health and former Chair of the Health Select Committee, said:

“As former health Ministers, we are all too aware of the limitations of the traditional command and control Whitehall approach.  Levers are pulled but action does not necessarily follow. For us it is increasingly clear we must not only integrate our NHS and social care services but also relocate the NHS within a new and comprehensive framework of devolved delivery. We cannot go back to where we were. There needs to be a ‘new normal’.”

Rt Hon Alistair Burt, former Minister of State for Community and Social Care, said

“After long deliberation and years of experience, we are clear about the case for change, submit this report as a formal contribution to that debate and call on the Government to meet its aims of building back healthy, resilient and prosperous communities through radical comprehensive health devolution. I very much hope that it will consider in depth its four recommendations including giving legislative support to comprehensive health devolution and establishing new mechanisms of accountability and scrutiny.”

Phil Hope, former Minister of State for Care Services a co-author of the report, said:

“The Covid-19 pandemic has had a far-reaching and profound impact on the future of our health, social care, public health and economic landscape. If ever there was a compelling ‘burning deck’ of circumstances that requires an urgent and radical response it is now.  The Government should commit to the principle of comprehensive health devolution and implement a rapid delivery programme across England starting with the acceleration of integrated workforce planning and management.

“Comprehensive health devolution is defined as the creation of healthy, resilient and prosperous communities through place-based, democratically led, local partnerships that adopt a ‘health in all policies’ approach and explicitly aim to: 

·         improve patient health and social care outcomes

·         improve the population’s health and reduce health inequalities

·         deliver a single local NHS, social care and public health service

·         combine health improvement with economic prosperity”

Organisations who gave advice and supported the work of the Commission welcomed its publication:

Sally Warren, Director of Policy at the King’s Fund, and Chair of the launch event, said:

“Health devolution is already underway in different ways and in different areas across England and a more system and place based approach to health and care is an important part of the ambitions in the NHS Long term plan.  There is a lot to learn from those areas at the forefront of genuine local devolution about the benefits this can bring for communities. However, until now there has been no common, consistent or comprehensive analysis of what good heath devolution looks like, the benefits it brings or how it should be developed. 

“The Health Devolution Commission took written and oral evidence from more than thirty key organisations and had more than six months of deliberations. It is the first report since Covid19 to be putting forward a viable model of comprehensive health devolution that would put the health and wellbeing of local communities at the heart of a locally led approach to services, delivering parity of esteem and integration between the NHS, social care and public health.”

Steve Barwick, Director of DevoConnect, and co-author of the report, said:

“Comprehensive health devolution is not only better for social care and for public health but it could also play a crucial role in achieving the Government’s “levelling up” agenda. By joining up health and wealth, Mayoral Combined Authorities have the opportunity to tackle the economic and social issues that cause physical and mental ill health – for example jobs and skills as well as housing and transport.  

“There has never been a more important time to think radically about the future. We can build back better health and prosperity, improve public services and tackle health inequalities within and between different parts of the country. But plans need to go beyond current non-statutory ICSs. Within 12 months all parts of England plans should develop a comprehensive health devolution mandate that reflects local boundaries and organisational footprints and is agreed with locally elected leaders.”

Sophie Corlett, Director of External Relations, Mind, added:

“We welcome this report and its contribution to the debate about the future of the  health and social care system. Devolved healthcare should be based on genuine, deep-rooted and equal partnerships with people with lived experience, carers, health professionals, local communities and the voluntary sector, as well as local employers and trades unions. It is particularly important to involve as diverse a range of people and organisations as possible so that health and social care services can appropriately and effectively serve their local communities.”

Christina McAnea, Assistant General Secretary of UNISON, said:

“Social care requires top to bottom reform so the lives of workers and the people they look after are improved. This cannot happen unless we listen to and respect those who know best – the managers and staff who provide and oversee the services. Care staff have been undervalued and ignored for too long. They need to be properly rewarded for their skilled work, as do NHS employees.”

Dick Sorabji, Deputy Chief Executive, London Councils, said:

“Councils are uniquely placed to understand and respond rapidly to the changing health and care needs of communities. This report provides essential and timely insight, and will provide critical learning as policy makers consider the future reform of health and care. The experience of responding to the pandemic has shone a light on the powerful role councils and their local health partners play in delivering real change on the ground. The future of health and care working must harness and build on this.”

Cllr Ian Hudspeth , Chair, LGA Community Wellbeing Committee, said:

“This report makes an important contribution to the devolution debate and about how we lead, plan and deliver better health and wellbeing services and better outcomes for our communities.  It identifies shared clinical, political and community leadership as crucial to meeting the challenges facing us as we attempt to navigate our way through existing challenges that have been sharply magnified by the impact of Covid-19 on all aspects of our lives.  We strongly agree that it is local, not national leaders that need to reshape the new health, care and wellbeing landscape”.