London Healthcare and Social Care Devolution Could Lead to the Destruction of Our NHS

On 15 December 2015 the government announced – somewhat out of the blue – that healthcare and social care is to be devolved in London. Agreements have been signed with all London CCGs and Local Authorities. However bizarrely the London Ambulance Service is not included in the devolution deal.

Five new devolution pilot schemes were announced. They are all concerned with integrating services. None of them are in West London. The largest is in Barking & Dagenham, Havering and Redbridge. Here a new Accountable Care Organisation (ACO) is to be created. This ACO will ultimately control the healthcare and social care spend for the combined authorities of £1.2 billion. One assumes this will be the first of many ACOs. Very worrying is the fact that ‘partner’ organisations involved in these pilots have agreed to look at local flexibilities in payment and tariff mechanisms. Make of that what you will.

No budget was announced for London care devolution. However the Manchester care devolution announced in May 2015 carried a budget of £6 billion. With just over three times as many residents in London compared with Manchester a budget of at least £18 billion can be expected for London.

The London devolution agreement needs to be read in conjunction with the draft Cities and Local Government Devolution Bill 2015/16 currently at committee stage in Parliament. Clauses 8 and 17 in this Bill provide for the dissolution of NHS bodies and the transfer of their functions and assets to Local Authorities or combined authorities.

If local government effectively takes over procuring healthcare services will the healthcare budget be ring fenced? Will local/regional care priorities hold sway over national priorities? Who will hold the whip hand in an ACO? Will it be the (NHS) healthcare folks or the (Local Authority) social care executives?

Just how might this London devolution impact NHS North West London’s ‘Shaping a Healthier Future’ (SaHF) vision/strategy/programme? Well SaHF prescribes changes to  healthcare and not social care and does not address integrating primary healthcare, secondary healthcare and social care. SaHF is already unproven, late, over budget and unfunded. Maybe soon it will become a dinosaur because it does not address integrated care.

One thing is for sure and this is that yet more future upheaval in managing and delivering healthcare and social care in Ealing is on its way.
One can see a future of a patchwork quilt of devolved ‘care’ regions – Manchester, London, Cornwall, Birmingham, etc. There will be no mandated consistency of approach to care in these devolved regions. Our national healthcare body (our NHS) could well disappear and our national social care body – which never existed – will stay unborn.