London NHS devolution deal signed

Chancellor George Osborne and health secretary Jeremy Hunt have signed a health devolution deal for the NHS in London, that follows a similar agreement for Manchester.

The agreement, which was signed today at Great Ormond Street Hospital, will begin with five integration pilots across the capital, including the creation of an accountable care organisation in Barking and Dagenham, Havering and Redbridge.

Accountable care organisations are a US innovation in which a group of providers take responsibility for all the care for a given population, often in return for a capitation payment.

They are a relatively new innovation in the UK, but since NHS England’s chief executive, Simon Stevens, spent a period of his career in the US, they are often seen as a possible direction of travel for NHS integration initiatives.

In north east London, the development will see a large part of the budget controlled by NHS England handed over to an integrated organisation being developed by the three borough councils, two clinical commissioning groups and two NHS trusts.

They argue this will help the local health economy to address an annual deficit that is projected to reach £440 million, by enabling more money to be directed to prevention and primary care.

The parties to the bigger agreement are London Partners, which comprises all of London’s CCGs, local authorities, and the Greater London Authority, and relevant national bodies, including the Treasury, the Department of Health, and its arms length agencies.

It says the different bodies involved will use a “co-production” approach when considering devolution proposals, and that any plans that are taken forward must both “strengthen” the NHS and uphold its values.

Healthcare services will continue to be run by the NHS. However, one of the purposes of the agreement is to give national and local bodies the “flexibility” to vary tariff and payment mechanisms, to support longer-term planning or experiment with different service models.

The government has also indicated that it will look at “local adaptations to provider regulation by the CQC and NHS Improvement [the regulator that has replaced Monitor and the Trust Development Authority]” so their rules don’t get in the way of innovative ideas.

At the signing, 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 lead to better, more joined up healthcare in London.”

The agreement does not mention technology, but other integration initiatives – including the ‘integration pioneers’ set up by former health minister Norman Lamb, and the ‘vanguard’ projects set up in response to the ‘Five Year Forward View’ – have tended to emphasise the need for good systems to deliver data to planners and shared care records to health and social care staff.

The agreement does say there will be a new focus on public health. One of the five pilot projects, in Haringey, will test new approaches to public health, with the council looking at what it can achieve using its planning and licensing powers to address the underlying determinants of ill health.

The other pilots will see Hackney integrating both health and social care services and budgets and Lewisham seeking to integrate physical and mental health services with social care.

The final pilot, covering Barnet, Camden, Enfield, Haringey and Islington, will specifically look at new approaches to managing the NHS estate.