NHS commissioning power ‘should be devolved to 38 super councils’

3 Nov 17

NHS England should be scrapped and £100bn worth of commissioning power be devolved to 38 new super councils, the Reform think-tank has stated.

Researchers said the current centralised commissioning process, which sees Whitehall spend 75% of the £335bn annual budget for public services, has failed to deliver outcomes “that matter” and provide value for money for taxpayers.

The think-tank described the existing system as “complex, fragmented, one-sized-fits-all” and called on central government to set “high-level outcomes” for local commissioners but take a “light touch” approach, allowing them the freedom to tailor commissioning to their areas.

Yesterday’s Vive la devolution: devolved public-services commissioning report said a “radical new offer” is needed but it stated the proposal could take 15 years to implement.

The report states: “The devolution agenda in England should be drastically accelerated.

“Commissioners need the power to design contracts for providers to meet local needs most effectively – in healthcare, employment services, skills and offender management.

“This requires commissioners to hold non-ring-fenced budgets, with maximum freedom to design contracts to offer to competitive public-service markets.”

The report proposes devolving 95% of NHS England’s budget, totalling £101.9bn in 2016-17, to 38 new councils, which would be led by a locally elected leader.

These local commissioning bodies would be financed through five-yearly block-grant funding, conditional on meeting high-level outcomes agreed with centre government.

Reform also called for responsibility for the commissioning of five employment-services programmes, including Jobcentre Plus, worth £1.5bn to be devolved to these authorities.

Twelve skills and apprenticeships programmes, totalling £3.2bn, and probation and youth-justice services, totalling £1bn, should also be devolved, according to the think-tank.

The study noted that eight devolution deals have been agreed across England, since the election of the first London mayor in 2000, with £7.4bn extra funding committed over 30 years.

But it said devolution of public-services commissioning has been no more than “delegation”.

For example, it said Whitehall still controls key commissioning functions, such as national contracts within Greater Manchester’s healthcare devolution deal.

In conclusion researchers said: “Government must be brave to drive the legislative and cultural change necessary to make this work.

“But it would be working with the grain: recent governments have set the devolution ball in motion, and the governance structures necessary already exist.

“This provides an important platform from which government, at all levels, can provide a vision; a vision for more effective public services that work for all.”

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