Response to LGA's devolution discussion paper
The Local Government Association (LGA) launched the "What next for devolution?" green paper to stimulate debate and conversation in councils and with local partners and wider stakeholders to agree some key principles which will underpin the next phase of devolution.#
NHS Providers welcomes the publication of this paper and the opportunity to comment. While the paper has been written primarily for a local government audience, we see that it is important to examine the legitimate role likely to be played by other parts of the public sector in delivering devolved systems
Key points in our response:
- While healthcare provision is branded as national, it is mostly commissioned and delivered by local bodies. Most clinical commissioning groups operate at sub-regional level, often covering only part of a local health economy. So for healthcare providers, the devolution debate is more about pooled sovereignty so that some decisions can be taken regionally than it is about devolving powers from the centre.
- To share a common understanding, a common definition of what devolution means is needed generally and for health and care specifically.
- The principles of subsidiarity are of central importance. Most decisions, whether strategic, managerial or about the care of individuals are best made locally. A smaller number are best made at regional or health economy-wide level and fewer, but strategically crucial decisions, need to be made at a national level.