Dr Marc Rowland, Chair of the London Clinical Commissioning Council and Lewisham CCG, on how devolution will pave the way for improving the health and wellbeing of all Londoners
The signing of the landmark London Health and Care Devolution Memorandum of Understanding marks a major milestone in our on-going efforts to make London the healthiest major global city.
Signed by the Mayor of London, Sadiq Khan, Secretary of State for Health, Jeremy Hunt, Chief Secretary to the Treasury, Elizabeth Truss, Chief Executive of NHS England Simon Stevens, London Councils, Public Health England, NHS Improvement and myself it confirms the commitment to speed up health and care transformation through the devolution of powers to within the London system.
Since the publication of Better Health for London in 2014, London’s clinical commissioning groups (CCGs) have worked tirelessly to make the best use of health assets, commission high quality sustainable services and support Londoners to lead healthier independent lives.
More recently, the London Health and Care Devolution Programme and five London devolution pilots have explored how moving resources and decision-making more locally could accelerate the improvements that Londoners want to see.
The devolution deal means London now has more control over decisions about integration, estates and prevention that will give commissioners real opportunities to improve health and care for their communities.
Devolution has enabled us to consider how we can support CCGs, their partners and boroughs to help make integrated care a reality faster, and at greater scale. Going forward, the London Health and Care Strategic Partnership Board (SPB) – which includes a CCG representative for each of the five London Sustainability and Transformation Partnerships – will champion this work. All primary care and some specialised commissioning have been devolved to London. Subject to the appetite of local areas, more localised and streamlined commissioning arrangements could better enable CCGs and London boroughs to work together to commission services. Decisions on how to invest national transformation funding will also now be taken in London by the SPB.
The NHS would not exist without its workforce. Going forward, the newly established London Workforce Board will bring together health and care partners and ensure a collaborative strategic approach to London-wide issues. Given the London-specific challenges in staff retention and turnover, the MoU also enables us to collectively work with the Department of Health to explore London weighting.
The NHS is one of the largest owners of land and buildings in London; up to three times the size of Hyde Park with an estimated value of more than £11bn. For too long, it has been time consuming, expensive and burdensome to free-up this money and reinvest it into improving community and primary care services, but today’s deal means the processes will be simplified. The release of unused land will also create the opportunity to develop more housing.
Currently, a high proportion of London’s primary care estate is in poor condition with 13 per cent requiring rebuilding and 51 per cent in need of refurbishment. Devolution means that money from the sale of NHS-owned assets will be available for much-needed primary and community care and wider public services in the capital. The London Estates Board will bring together London and national partners to support the release of capital from surplus NHS estate and land to be reinvested back into the city’s health and care system. This new way of working will speed up decision-making and make sure improvements happen much faster than the current five to 10-year average waiting time to develop NHS estates.
In terms of prevention, commissioners will be able to draw on the evidence generated by the devolution pilots and trial activities that are appropriate for their local area. Where an evidence base for change is successful, local areas will have an opportunity to draw new prevention powers into local plans.
London will work with the Department for Education to ensure that revenue from the soft drinks industry levy is able to achieve the best value for young Londoners. Options to further restrict the advertising and marketing of unhealthy food and drink in specific locations will also be explored. A borough-led London-wide illegal tobacco and counterfeit alcohol enforcement team will be established.
Prevention efforts will be coordinated through the refreshed London Prevention Board and a collaborative prevention programme that enables links to be made between work underway through the boroughs, DPH network, GLA and NHS.
Healthy London Partnership is also evolving to support transformation more broadly through wider and more formal collaborations with the GLA, London Councils, Public Health England and wider partners. By leveraging diverse partner funding, expertise and delivery networks, we can maximise our impact and work in a more efficient way.
It has been an exceptional journey of partnership working to get us to today’s devolution deal.
On behalf of the London Health and Care Devolution Programme, I would like to express our immense gratitude to all those in London’s clinical commissioning groups who helped to shape the final deal.
Over the coming months, we are keen to strengthen engagement with CCGs across London to make sure the next steps meet your needs and result in improved health and care for Londoners.
Join us in making the most of this opportunity and enable London to be the healthiest major global city.
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