Following last month’s progress towards the capital’s retaining a larger share of business rates raised here, London government is now applauding a further “ground-breaking devolution deal” with national government to devolve more control over health and care services. Why is that good?
The main reason is the usual one for enabling decisions about the delivery of important services to be made closer to the people who use them – you tend to get better decisions. And in this case the new local autonomy is also intended to make it easier for the NHS and local authority social care services to work together in the best interest of Londoners.
Sadiq Khan has called the deal “a really important step in the right direction in our journey to becoming the world’s healthiest city” and Haringey leader Claire Kober in her capacity as chair of London Councils said that the five pilot schemes, agreed in December 2015, that have tested this new approach in London have “demonstrated the clear benefits of partnership working at local level”.
The deal is in part a recognition that, as in many other respects, London’s population and its way of life are distinctive, not least in their diversity, so it makes sense to be able to tailor services accordingly. The London Health and Care Devolution team’s explanatory document emphasises that Londoners are “much more mobile” than people elsewhere in the country, “moving around the city to live, work and access their care”.
They add that rapid population growth in general means we will have many more older people, who are, of course, the biggest users of health and social care services – the number of over 80-year-olds is projected to rise by 88% by 2039. At the same time, too many of the nearly one third of Londoners under 25 years old are overweight, and the hope is that this will be more effectively tackled from the local level.
More “joined-up” and “person-centred” care system is seen as both more responsive to the needs of particular communities across the city and better at providing the sorts of advice and early interventions that help people to look after themselves better and so make them less likely to fall ill in the first place.
Another aspect of the devolution deal is that NHS Trusts in London will, in the words of the explanatory document, “be incentivised to sell unused land and buildings and reinvest the money back into London’s health and care system”, including other existing premises, and also release land for new homes and schools, which London also needs more of.
Read the London Health Care and Devolution Team’s explanatory document here.