Devolution deal for London opens door to radical NHS integration plans

Health and care services in London are to be devolved, paving the way for a 'radical transformation' that integrate primary and secondary care in parts of the capital.

London: capital set to follow Manchester into devolved NHS deal
London: capital set to follow Manchester into devolved NHS deal

The government, NHS and local authorities have signed an agreement to devolve control of health and care services to local commissioners and councils.

In February the government signed a similar devolution deal with the NHS and local authorities in Greater Manchester which will lead to a single £6bn budget for health and social care across the region.

The London agreement, signed on 15 December at the Great Ormond Street Hospital, will begin with five new integration pilots across the capital.

  • In Barking & Dagenham, Havering and Redbridge in north east London a new accountable care organisation (ACO) will integrate primary and secondary care and redesign patient pathways with a focus on early intervention and managing chronically ill patients.
  • Lewisham will run a pilot seeking to integrate physical and mental health services alongside social care.
  • In Haringey a prevention pilot will use planning and licensing power to develop new approaches to public health.
  • Hackney will run a health and social care integration pilot, aiming for full integration of health and social care budgets and joint provision of services. This will also have a focus on prevention.
  • Barnet, Camden, Enfield, Haringey and Islington will run an estates pilot testing new approaches to collaboration.

Chancellor George Osborne and health secretary Jeremy Hunt signed the agreement with ‘London partners’ including all of London’s CCGs, local authorities, the Greater London Authority and national bodies including NHS England, Health Education England, NHS Improvement and Public Health England.

NHS devolution

Mr Osborne said: ‘Today’s agreement is another crucial step in our devolution revolution and is the start of us handing over valuable healthcare power to local leaders in London. This deal means that not only will the people of London have more control over decisions that affect their lives, it will also lead to better, more joined up healthcare in the capital for Londoners.’

The agreement aims to develop new care models with the five pilots leading in the longer term to further devolution of control to local health and civic leaders.

Under the plans the partner organisations agree to look at local flexibilities on payment and tariff mechanisms and to test new mechanism developed by the new care models programme which could see integration of primary care budgets with those of other services.

The government and NHS England have agreed to publish indicative multi-year allocations for CCGs to help planning. The government has also agreed to look at possible local adaptations to provider regulation by the CQC and NHS Improvement.

NHS leaders in north east London said the new ACO pilot would see a large part of the budget currently controlled by NHS England and HEE handed to the new integrated organisation being developed by three borough councils, two CCGs and two NHS trusts.

NHS deficit

The local health economy is facing a potential annual deficit of up to £440m. Health and civic leaders want more of their funding to be spent in primary care and believe an ACO will give them the flexibility to do so.

Joint senior responsible officer for the ACO and chief officer of the CCGs Conor Burke said: ‘This represents a significant step towards overseeing the £1.2bn health and social care budget for the area. We already have some great examples of integrated care, but this would break down any remaining barriers so that residents receive a seamless service from two parts of the system which are so reliant upon each other.’

Joint senior responsible officer and the London Borough of Havering chief executive Cheryl Coppell said: ‘With a greater focus on prevention and primary care through the ACO, we firmly believe we can deliver a real positive difference for our residents’ health.’

Jeremy Hunt said: ‘This exciting new deal will help improve services even further for Londoners. The pilot areas we have announced today will be trailblazers as we move towards a fully integrated health and care service by 2020.

‘By empowering more places in the capital to make the best decisions for themselves we will improve patient experience, and help keep people well for longer.’

Mayor of London Boris Johnson said: ‘This agreement paves the way for a revolution in how health and social care are delivered across the capital. With our city’s population continuing to grow, it is essential that we have a health service better equipped to manage its own resources so that it can become even more responsive to the needs of Londoners.’

NHS England chief executive Simon Stevens said: ‘Today the NHS and London local government commit to testing better prevention for our children’s health, to new ways of joining up care for older people, and to shared action to free up unused buildings and land to reinvest in the modern primary care that our fast growing city clearly needs.’

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