London Health and Social Care Devolution

Greater London was not covered by the Cities and Local Government Devolution Act 2016. Despite this, in December 2015, the London Health and Care Collaboration Agreement was published and was intended to transform health and care provision across London.

All London clinical commissioning groups (CCGs), local authorities and the Greater London Authority were signatories, alongside national bodies which included HM Treasury, the Department of Health, the Department for Communities and Local Government, NHS England, Health Education England, NHS Improvement and Public Health England.

It described London’s three key areas of focus:

• prevention
• health and care integration
• estates.

Given the complexity of providing services in London, five local and sub-regional devolution pilots explored how greater collaboration, integration and devolution could work in practice, including impacts within and beyond the London system. Once the pilots had developed detailed plans, any devolution of health powers would be subject to careful consideration by government and national bodies.

Under any proposals that were agreed, health care services in London would remain part of the NHS.

Memorandum of understanding

On 16 November 2017, the Mayor of London, Secretary of State for Health Jeremy Hunt, London Councils and NHS, Public Health and wider health and care leaders signed a Memorandum of Understanding on London Health and Social Care Devolution, which built upon the 2015 commitments.

The document outlined that insight from the pilots had found that decision-making and powers were better administered at different spatial levels within London.

The main themes that arose from the commitment were to create greater incentives for NHS organisations in London to sell surplus land, which would generate revenue for investment in primary and community care facilities. Additionally, alignment of regulatory processes and piloting a place-based framework for system regulation aimed to encourage integration. There were few firm commitments in relation to prevention and public health, which the King's Fund described as ‘missed opportunities’.