Big changes are coming to the way decisions are made about services across the UK.
One of the biggest payoffs of devolving power in England is outcomes-based policymaking. Rather than delivering services under segregated policy remits (education, transport, housing, etc), which are measured by inputs and outputs, devolution offers the potential for mobilising diverse constellations of actors to collaborate on improving key outcomes.
Health inequalities, climate breakdown and stalling productivity are archetypal examples of the urgent cross-cutting policy challenges that require such collaboration.
The devolution of policymaking capacity is the only viable way forward. Whitehall has repeatedly failed over decades to overcome its policy siloes, suggesting that the UK’s departmental fiefdoms are the product of deep-rooted political structures, rather than merely a lack of political will.
Create coalitions
However, the galvanising power of ‘place-making’ offers an overarching call to arms that can create coalitions of change among local politicians, public officials, business leaders, universities, charities, local media and the general public. Harnessed correctly, this can create innovative and lasting policy interventions that begin to shift entrenched problems.
Investing in Regional Equality: Lessons From Four Cities – a report from CIPFA and the City Region Economic and Development Institute (City-REDI) at the University of Birmingham – outlines the key factors in realising this potential. It builds on their previous international research. All 10 success factors identified are important for delivering cross-sector policymaking, but some are absolutely crucial. ‘Shared political will and partnerships’ is needed to ensure that different institutions are able to work together. ‘Clear vision and strategy’ is needed to ensure they have something to work towards. And ‘adequate and responsive funding’ is needed so that they have something to work with.
This is also clear from our own research on the TRUUD (Tackling Root Causes Upstream of Unhealthy Urban Development) project. This focuses on how the urban environment affects public health, particularly issues such as transport, housing and planning, which are increasingly the remit of local and mayoral authorities.
Improving public health cannot be the responsibility of the NHS alone. It requires policymakers in all sectors to embed health considerations in their decision-making. This is not happening in central government. But there are some really positive examples at a local level, such as the Frome Gateway regeneration area in Bristol and the Streets for All project in Greater Manchester.
There is also the example of South Yorkshire, highlighted in the CIPFA/Citi-REDI report, where the mayor has made health and wellbeing the region’s top priority, and has forged a closer relationship with the local integrated care partnership.
There is, however, one issue above all others that defines the governance challenge in contemporary England: funding. After many years of austerity, local authority finances are in an increasingly perilous situation, with some facing drastic emergency cuts to core services.
It is not just the scale of funding that is the challenge but how it’s delivered. The CIPFA/City-REDI report highlights the short-termism and inefficiency of funding, calling for funding simplification and more single-pot budgets. Central government is travelling in this direction – but not fast or far enough.
More needs to be done to fix the broken, multi-level funding system in England. To make any traction on health inequalities, or any of the other major cross-cutting policy challenges, there needs to be a fundamental rethink of how frontline services are funded. This could be in the form of ‘place-based budgets’, in which all the funding in a local area is drawn together under a set of long-term local priorities.
Whatever the detail, funding must be driven by local priorities. Instead of being scattered across disjointed interventions and wasted on ‘firefighting’, public (and private) investment needs to be corralled towards strategic outcomes-based policymaking.
