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Landmark ‘devolution’ deal will improve health and care in capital, say politicians

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A deal unveiled today will give London’s NHS and councils the “freedoms and powers they need to provide the very best health and care services”, according to the chief nursing officer for England.

The new “devolution” deal could potentially lead to London taking more control over the commissioning of its primary care and specialised services, bring its health and care services closer together and accelerate the selling off unused NHS land and buildings.

“It is vital that the capital has the powers to plan and co-ordinate health services”

Sadiq Khan

The London Health and Care Devolution Memorandum of Understanding has been signed by mayor of London Sadiq Khan, health secretary Jeremy Hunt and NHS, public health and council leaders.

The agreement, announced today, is designed to give the mayor and local leaders more control over health and care in the capital, leading to improvements via more “joined-up” services for Londoners.

It is the largest deal of its kind in England, with over 100 organisations involved, and was hailed by Mr Khan as “a really important step” towards London becoming the “world’s healthiest city”.

The deal is designed to bring the capital’s health and social care services closer together by helping to remove barriers to organisations working together, such as on payments, regulation or workforce.

“There is a huge amount of good practice and innovation in London’s health and care services”

Jeremy Hunt

The memorandum document stated that “some” of NHS England’s current functions “may be devolved or delegated from the national level to within the London system”.

“This will include the commissioning of primary medical services and exploring options around the commissioning of some specialised services,” it said.

Paving the way for the deal, over the past two years, pilot projects across five areas have been exploring new ways of working to help streamline care, improve services and drive prevention.

The pilots have been exploring how to bring decision making between local authorities and clinical commissioning groups closer together to improve the health and wellbeing of local communities.

The deal document said work would now start to “overcome barriers” to implementing such shared arrangements to support personalised and joined up care at local, multi-borough and London levels.

“National partners will also work with London to develop, adopt and implement innovative payment models at pace and scale,” it added.

The five devolution pilot projects took place throughout 2016-17 in the following areas:

  • Haringey explored the use of flexibilities in existing planning and licensing powers to develop new approaches to public health issues
  • Barking and Dagenham, Havering and Redbridge explored integration, developing plans for an Accountable Care System, bringing primary and secondary care more closely together and patient pathways redesigned with a focus of early intervention and managing the chronically ill
  • North Central London (Barnet, Camden, Enfield, Haringey and Islington) focused on estates issues, testing new approaches to collaboration on asset use
  • Lewisham worked to integrate physical and mental health services alongside social care
  • Hackney developed health and social care integration plans working towards full integration of health and social care budgets and joint provision of services – with a particular focus on prevention

Part of the deal is also intended to release money from the sale of NHS property for primary and community care and wider public services, as well as the opportunity to develop more housing.

A new London Estates Board will be set up to support the release of capital from surplus NHS estate and land, speeding up decision-making than the current five to 10-year average time.

A statement announcing the deal noted that the NHS was one of the largest property owners in London, with land three times the size of Hyde Park and an estimated value of more than £11bn.

NHS England/NHs London

England’s chief nurse to oversee health service in the capital

Jane Cummings

But it also highlighted that a high proportion of London’s primary care estate was currently in poor condition, with 13% requiring rebuilding and 51% in need of refurbishment.

CNO Professor Jane Cummings, who is also interim regional director for NHS England London, said: “London is the greatest capital city, with an ambition to be the world’s healthiest too.

“We’re already making progress towards this, but today’s historic devolution deal will accelerate these efforts – giving London’s NHS and councils the freedoms and powers they need to provide the very best health and care services for the capital’s 8.6m residents,” she said.

Mr Hunt said the agreement would put London’s population in the “driving seat” about the health and care it received. “I know there is a huge amount of good practice and innovation in London’s health and care services, and this is will help them to go further and faster in improving patient care,” he said.

Sadiq Khan

Sadiq Khan

Sadiq Khan

Meanwhile, Mr Khan said it was “vital” that London had the powers to plan and co-ordinate services that both met the needs of local communities and ensured residents had “proper access” to them.

“Today is a really important step in the right direction in our journey to becoming the world’s healthiest city,” said the mayor.

Claire Kober, chair of London Councils, said: “Through the work of the devolution pilots, the capital has demonstrated the clear benefits of partnership working at a local level.

She said it was “crystal clear” from the pilots that Londoners were “crying out” for a health and care system that ensured access to high-quality treatment “when and where they need it”.

“Devolving power locally, and building a real partnership between local government and the NHS, is the best way to deliver this,” she added.

Organisations signed up to the devolution agreement are:

  • All 32 London clinical commissioning groups (CCGs)
  • London Councils; 32 London boroughs and the City of London
  • Greater London Authority (GLA)
  • HM Treasury (HMT)
  • Department of Health (DH)
  • Community Health Partnerships (CHP)
  • NHS Property Services
  • Department for Communities and Local Government (DCLG)
  • Department for Work and Pensions (DWP)
  • Department for Culture, Media and Sport (DCMS)
  • Department for Education (DfE)
  • NHS Commissioning Board, Health Education England (HEE)
  • NHS Improvement
  • Cabinet Office
  • Care Quality Commission (CQC)
  • National Institute for Health and Care Excellence (NICE)
  • Public Health England (PHE)




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