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Former health ministers give warning that Health and Care Bill could lead to greater centralisation unless key principles embedded

21 June 2021

Five former health ministers, including Greater Manchester Mayor Andy Burnham and Rt Hon Norman Lamb, are calling on Government to “level up health” through its forthcoming Health and Care Bill.

The cross-party Health Devolution Commission, whose supporters include the LGA and the NHS Confederation, says the pandemic provides a unique opportunity to rethink as well as reorganise how health care is delivered. However the Commission’s report ‘Levelling Up Health’ also warns that unless key principles included in its many recommendations are acted upon the Bill could lead to greater centralisation of NHS, social care and public health services.

‘Levelling Up Health’, makes 28 detailed recommendations to the Government’s Health and Care Bill including on the purpose of the reform and the future power relationship between the NHS, local government and other stakeholders including the VCSE and patient representative bodies. It says better – more personalised, local and integrated – NHS, social care and public health services and a relentless focus on addressing health inequalities should be at the heart of the Government’s reorganisation.

The six most noteworthy recommendations are appended below.

Co-Chair of the Commission and former Health Minister during the Conservative-Liberal Democrat Coalition Government, Rt Hon Norman Lamb, said:

“If the recommendations in this report are embraced by the Government and NHS England then there is a real opportunity to do health differently and in a way which has a genuinely positive impact on the health and prosperity of our local communities. There is, however, a danger that unless these changes are accommodated in the imminent Health and Care Bill the Government’s reforms could lead to greater centralisation not decentralisation of NHS, social care and public health services.

“The White Paper offers the chance of using resources more effectively and of unleashing the power of local organisations and communities to improve health and prosperity but the proposals need strengthening in the way we have suggested in order to realise that vision.”

Co-chair of the Commission, the Mayor of Greater Manchester – which has been pioneering the Integrated Care System model that the Government plans to roll-out across England – and former Secretary of State for Health under the last Labour Government, Rt Hon Andy Burnham said:

“The case for the long-overdue reform of health and social care in this country has never been stronger, but it has to be done right. This report sets out three core principles which must drive that reform if we are to create an effective integrated system fit for the future.

“The first must be establishing a genuine partnership of equals between the NHS and local government to deliver person-centred care.

“The second is that real levelling up must underpin all of these reforms: levelling up between DHSC and local government, between NHS services and social care, between physical and mental health, and between treatment and prevention. All of this is crucial to redressing the stark health inequalities that still exist across the country.

“The third is that there is a commitment to putting local expertise at the heart of these plans. It must be our local authorities with adult social care responsibilities, like those here in Greater Manchester, that are the building blocks of Integrated Care Systems. This is the starting point to take forward integration and delivery, and to ensure effective, place-based services for local communities.”

SIX KEY RECOMMENDATIONS FROM LEVELLING UP HEALTH

Population health improvement and reducing health inequalities should be primary purposes of ICSs that are written on to the face of the Bill

ICSs should promote a ‘health in all policies’ approach and encourage greater action by other public, voluntary and private sector organisations

The Government should make a public commitment to parity of esteem between the NHS and Local Government

The Government should publicly acknowledge that ‘place based partnerships’, based on the principle of subsidiarity and the footprints of councils with adult social care responsibilities, are the building blocks of the Integrated Care Systems and the principal level at which integration, and delivery, of services should be taken forward.

The presumption should be that the ICS Partnership is chaired by a Local Government leader – or Metro Mayor if agreed by a relevant Combined Authority – and include a range of members from the NHS, Local Government, Universities, LEP(s), the Voluntary, Community and Social Enterprise (VCSE) sector and patient representative bodies.

The ICS NHS Board should fulfil its mandate in ways that are compliant with the ICS Partnership’s Health and Wellbeing Plan. The Government should produce detailed statutory guidance on how the ICS NHS Board will have ‘due regard’ to the plan of the Partnership including a ‘comply or explain’ approach.

Read the full report here.

CROSS PARTY HEALTH DEVOLUTION COMMISSION PROPOSES THIRD OPTION ON INTEGRATED CARE

11 January 2021

INTEGRATING CARE: A UNIQUE OPPORTUNITY TO BUILD BACK BETTER HEALTH AND PROSPERITY

The Health Devolution Commission, co-chaired by Andy Burnham and Norman Lamb, has submitted evidence on the future of integrated care. It welcomes NHSE’s proposals as “a major step forward towards its vision of comprehensive health devolution and collaborative ways of working”, but believes “there is a strong case for going further and giving local areas more choice about the nature of their local system in order to deliver better NHS and social care services, and build healthier and more prosperous communities.”

The Commission’s preferred option is that a third “Health and Prosperity” model of Integrated Care Systems is added to the two proposed in the NHSE consultation, which closed on Friday 8^th January. It also believes there is a case for dispensing with “the technocratic term” Integrated Care Systems and adopting the title Integrated Care Partnerships to better reflect that the next iteration of reform must be predicated on a genuine partnership between the NHS and local government as well as clinical and third sector stakeholders.

Andy Burnham, Co-chair of the HDC, Mayor of GM and former Health Secretary said:

“The Covid crisis has shone an even sharper spotlight on the struggles of our social care system, which, despite the incredible sacrifices and efforts of many thousands of outstanding staff, I have argued has been broken for a long time. The pandemic has also demonstrated the need for a ‘health in all policies’ approach.

“We must be radical in how we improve the system and build on where local partnerships are already working. That’s why we are proposing a third ‘Health and Prosperity’ model of Integrated Care System bodies. This would extend the two options being proposed and give more autonomy to local ICS bodies to tackle health inequalities. It would also help secure an integrated approach to NHS and social care services as well as improve the health and economic prosperity of their communities. This model also recognises devolution in England and devolving power and budgets to more local and regional areas are the best way to deal with health and social care issues in those areas.”

Norman Lamb, Co-chair of the HDC and former Health Minister said:

“The next iteration of ICS bodies must avoid becoming a technocratic rearrangement of traditional ‘command and control’ in the NHS, predicated on a model in which ICS bodies are clinically led and primarily accountable to NHSE or central Government. The Commission also believes there is a case for dispensing with the technocratic term Integrated Care Systems and adopting the title Integrated Care Partnerships.

The principles of effective integration of health and social care are: a person-centred and co-productive approach; collaborative leadership; subsidiarity – decision-making as close to communities as possible; and a preventative, assets-based and population-health management approach.

“The welcome replacement of competition – as an underlying principle of the NHS to drive health service improvement – with collaboration between commissioners and among providers requires alternative means of ensuring quality. The Commission suggests that the new collaborative approach should be accompanied by both greater local democratic accountability and enhanced external scrutiny.”

The key elements of the Commission’s proposal for an additional and optional joint “Health and Prosperity” model of Integrated Care System bodies are that this would allow them to:

Embrace a wider purpose to include better social care and public health services, tackling health inequalities and improving economic prosperity
Embed the principles of person-centred care, active citizen engagement, and ‘health in all policies’ in its ways of working
Ensure parity of esteem between physical health, mental health, social care and public health
Enhance local democratic accountability through joint civic and clinical leadership in a ‘partnership of equals’
Ensure single health and social care budgets and commissioning at the locality level
Enable the best alignment of new ICS body footprints with established boundaries of Local or Sub-Regional Government
Embrace health and social care workforce planning and management
Establish robust external scrutiny arrangements to ensure quality

Please click here to read the full response of the Commission.

BUILDING BACK HEALTH AND PROSPERITY

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 Guardian, Yorkshire Post, MJ 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.

COMPREHENSIVE HEALTH DEVOLUTION TO PROVIDE PARITY OF SOCIAL CARE WITH NHS AND TACKLE HEALTH INEQUALITIES

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”.

Further submissions

7 May 2020

Please click the links below to read the written evidence the Health Devolution Commission has received below.

Read Alzheimer’s Society submission here.

Read Assura plc’s submission here.

Read Breaking Barriers Innovations submission here.

Read Cancer Research UK’s submission here and most recent briefing here.

Read Chris Gibbon and Chris Brailey’s (Independent Management Consultants) submission here.

Read Healthier Fleetwood and Fleetwood Primary Care Network submission here.

Read Healthwatch England’s submission here.

Read NHS Health Education England’s submission here.

Read Peter Hay Consultancy submission here.

Non-Verbatim write up of roundtable with NHSA – here.

Written evidence submissions

3 April 2020

Please click the links below to read the written evidence the Health Devolution Commission has received below. Thank you to all the organisations who have submitted so far.

(Please note that we have extended the date for evidence to 01/05/20 due to the Covid-19 emergency. See the post below for more information.)

Read the Association of Anaesthetists submission here.

Read the Faculty of Sexual & Reproductive Healthcare’s (FRSH) submission here.

Read the General Medical Council’s (GMC) submission here.

Read Macmillan’s response and submission here.

Read MIND’s submission here.

Read the NHS Confederation’s submission here.

Read NHS Providers submission here.

Read Public Health England’s submission here.

Read the Royal College of Occupational Therapists submission here.

Read the Royal College of Radiologists submission here.

Read the University of Central Lancashire’s – Dr. Kimberly Lazo submission here.

Read West Yorkshire and Harrogate Health and Care Partnership’s submission here.

Background slides from Greater Manchester Health and Social Care Partnership – here

Briefing note from Cancer Research UK – here

Formal response to the Hewitt Review – A Great Step Forward

Informed by the Commission’s roundtable in March, which heard from Rt Hon Patricia Hewitt herself, the Commission concluded that there are five must do changes the government must implement to support ICSs and five other actions that need to be taken forward in conjunction with ICSs and wider partners.

ICS Best Practice roundtable I March 2023

The Commission held a roundtable focussed on the Hewitt Review of ICS and on ICSs’ best practice in response to the cost of living crisis. The write-up of that event which includes links to the slides presented and the Commission’s five conclusions and recommendations are available here. The recording of the roundtable is available here.

Health Devolution Commission Programme in 2022

Sets out a programme of research and roundtables to ensure the Commission remains a respected thought leader on health devolution as Integrated Care Systems are statutorily rolled out across England in 2022. Read here

Delivering the best Integrated Care Systems: roundtable series

Rountable 1: Opportunities, emerging best practice and challenges for Integrated Care Systems.

Watch our first roundtable discussion and read our write-up where we explore opportunities, emerging best practice and challenges for Integrated Care Systems. The video includes seven excellent presentations from the speakers, and the report covers the wide range of issues discussed – from optimism to shared outcomes, from place based approaches to governance, from transformation to future challenges.

Roundtable 2: Developing ICS Best Practice – Shared Outcomes to address Health Inequalities, with specific regard to Children & Young People’s Health and Wellbeing and 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.

Roundtable 3: Developing ICS Best Practice – Workforce development, partnerships at place and system regulation

A background briefing was prepared which provided key information on the issues of ICS workforce development, place-based partnerships and regulation. An update on policy and political developments was also circulated. The recording of the roundtable chaired by Norman Lamb is here along with the slides by Ofsted . See here for the MJ’s news article after the session.

Health and Care Bill: Briefings

House of Commons 2nd Reading briefing| Read here.

House of Lords briefing| Read here.

House of Lords briefing presentation| Read here.

Levelling Up Health: White Paper response

We need an equal partnership between the NHS and councils on health and care | Read here.

Final report: Levelling Up Health.

Coverage: The MJ , HDC Press release

Health Devolution Commission Inquiry Evidence Session II: The purpose of, and power relations in, future integrated care systems? | Watch

Health Devolution Commission Inquiry Evidence Session I: What is the purpose of Integrated Care Systems: Health in all policies, tackling health inequalities and a voice for patients? | Watch

A Glass Half-Full: White Paper response

Response to the Government’s White Paper ‘Integration and Innovation’: A Glass Half-Full

In January 2021 the Health Devolution launched their response to NHSE national engagement/consultation exercise: ‘Integrating care – Next steps to building strong and integrated care systems across England’. You can read ‘INTEGRATING CARE: A UNIQUE OPPORTUNITY TO BUILD BACK BETTER HEALTH AND PROSPERITY here.

Building Back Health and Prosperity: Report

Final report: Building Back Health and Prosperity

Is devolution the future of health and social care?: Essays

Collection of essays: here

Other:

Health Devolution Commission will promote the best integrated care system possible | 2022 press release

Launch of Health Devolution Commission Report | Watch

Third Meeting of the Health Devolution Commission 28.05.20 | Minutes

Initial Launch press release – here

The full scope – or terms of reference – for the Health Devolution Commission – here

First evidence session of the Health Devolution Commission – Friday 28th February – here

Publications

In August 2020 the Health Devolution Commission launched their report ‘Building Back Health and Prosperity’. The real value of the report will be whether it informs discussions in Parliament and Whitehall – as well as in Local Government, Combined Authorities and amongst the wider health and social care sector decision makers and influencers – regarding the future of NHS and social care services which are bound to intensify in September and thereafter.

In July 2019 DevoConnect published a collection of essays “Is devolution the future of health and social care?” The Health Devolution Commission builds upon this important body of work.

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

The Health Devolution Commission