Call for Evidence – NB Closing Date Now Extended

27 January 2020

THE HEALTH DEVOLUTION COMMISSION

AN INQUIRY INTO THE VALUE AND ACCOUNTABILITY OF DEVOLVED HEALTH SYSTEMS

Background

The Health Devolution Commission is conducting a cross party and expert inquiry into the value and accountability of devolved health systems. The members of the Commission include two former Health Secretaries and three former Health Ministers from the three main parties in England as well as senior professional figures from the health, mental health, social care and public health sectors.

It is widely recognised that unless action is taken to address the drivers of physical and mental ill-health (e.g. poor housing, poor diet, poor air quality, job insecurity/unemployment) at the same time as addressing the challenges of service integration within the NHS and between the NHS and social care, then the health service will always be subject to increasing demands and pressures with which it will struggle to cope.

However, whilst there is a growing body of evidence and advice about how the health and social care system in England can be better integrated, we need a better understanding of how the wider drivers of ill-health can be addressed in order to both build a community’s health and create a sustainable and person-centred health and social care system.

There is also a growing need to look at how accountability works within integrated systems as it is currently unclear what is, and should be, the relationship between ‘vertically structured’ NHS services and ‘horizontally structured’ Council or Combined Authority services such as social care, public health, regeneration and housing.

Health devolution is seen as one approach to place-based health service reform that has the potential to integrate not just disparate services within the NHS, and NHS and social care services in a locality, but to bring together in a combined strategy and structure all of the services and systems within a community that have an impact upon the health of a local population. Therefore, it may provide the means to better meet their health and care needs.

The Commission has therefore been established to learn the key lessons from the experience of health devolution within England in areas such as Greater Manchester and, to a lesser extent, London and the West Midlands as well as elsewhere in the UK through Integrated Care Systems, Integrated Care Providers and Primary Care Networks.

Your views on the possible benefits – and disbenefits – as well as the key political implications (with both a small and capital p) would now be most welcome.

Key Questions

The Commission is holding evidence sessions and calling for written evidence on two fundamental questions:

  1. What does good health devolution look like that builds a community’s health and improves a community’s health and social care services?
  2. How should the challenges of accountability, power and control between the NHS and local authorities be addressed in devolved and integrated systems?

Subsidiary questions of particular interest to the commission upon which contributions would be welcome are:

1          What does good health devolution look like?

  1. In what ways does health devolution enable the building of healthier communities and promote the prevention of ill-health?
  2. In what ways does health devolution enable the marshalling of a wide range of services and partners across local authorities, the NHS, community and charity bodies, and the private sector to address the wider drivers of ill-health in local communities?
  3. Are there any barriers to the potential benefits of health devolution being realised; and if so how could these be addressed?
  4. How does health devolution affect the outcomes and experience of care for people with specific conditions such as cancer or mental illness, or specific population groups such as older people with conditions such as dementia?
  5. To what extent does health devolution accelerate integration within the NHS and between health and social care services, and help make the NHS Long Term Plan a reality?

2          How can challenges of accountability, power and control be addressed in devolved and integrated health systems?

  1. What is the relationship between central government, NHSE and devolved health areas? In what way is the Secretary of State for Health and Social Care and NHSE held accountable for improving a community’s health as well as NHS performance in devolved health and social care systems?
  2. How can local leaders in devolved health systems be held accountable locally and nationally at the same time for the performance of locally integrated services?
  3. What is the nature of the relationships between local clinical leaders (health commissioners and providers) and civic (professional and elected) leaders? What decisions are each responsible for in a devolved and integrated system?
  4. How does health devolution affect policies to empower individuals to have more control over their health and social care services and outcomes?
  5. What impact does health devolution have on the charity sector, social enterprises and the independent sector as providers and partners in health and social care structures?

The Commission’s Findings

Our intention is that the Commission’s findings will be of value to policymakers at national, city region and local levels who are interested in adopting health devolution and will generate the following three outputs:

  1. identifying the potential of health devolution for place shaping, building healthier communities and transforming services to meet local health needs
  2. outlining the impact of health devolution on specific conditions such as cancer and mental health, and on specific populations such as older people
  3. identifying issues and potential solutions to the challenges of accountability, power and control in devolved health systems presented by the close working relationships required between local authority leaders and services; and local health leaders and services (service commissioners, clinical leaders, and health and social care providers in the public, private and third sectors)

Submissions and Timescales

Please submit your evidence and responses to these questions to [email protected] by Friday 1st May 2020. Please note you do not have to answer all the questions. Moreover, if you have additional information, views or evidence about health devolution outside of these questions please feel free to submit them. But, please, no more than 3,000 words in total

All submissions will be placed on the DevoConnect Health Devolution Commission website (Unless you specifically ask us not to); and you are encouraged to share widely your submission, and any comments you have on the submissions of others. The Commission intends to complete its work and publish its findings and recommendations by Summer Recess 2020.