Health and care devolution in London

London health and care partners have signed a devolution agreement with government


London's 33 local authorities, 32 Clinical Commissioning Groups (CCGs), the Mayor of London, NHS England and Public Health England have built on their shared vision set out in Better Health for London by signing a London Health and Care Collaboration Agreement (PDF).

The Chancellor and Secretary of State for Health have, in parallel, signed a devolution agreement with London (PDF).

At the signing of the agreements, the Chancellor of the Exchequer George 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 also lead to better, more joined up health care in the capital for Londoners."

Major Jules PipeMayor Jules Pipe, Chair of London Councils said:

'This agreement promises to be the beginning of a real partnership between all public services concerned with the health of Londoners.  It marks the culmination of much hard work between the boroughs, local clinicians in the CCGs, the NHS, Public Health England and the GLA.

Through greater integration of our services we intend to deliver better outcomes for Londoners to support them in living healthier, independent lives.  This agreement provides a strong joint framework for us to deliver that agenda together.'  

Read on for more information about the two agreements and the five pilots through which detailed devolution cases will be co-produced between local partners in London and government and national bodies.

Read the full Treasury press release (external link)

The London Health and Care Collaboration Agreement

This sets out a collective agreement by London and national partners to transform health and wellbeing outcomes, inequalities and services in London through new ways of working together and with the public.  

At its heart is the reform and updating of the way public services are provided, that recognises:

  • the need to shift from reactive care to prevention, early intervention, self-care and care closer to home that maximises people's independence and wellbeing

  • the scale and complexity of the health and care system in London - transformation will be driven at three geographical levels - local, sub-regional and pan-London
  • the need to tailor solutions to the different needs of people and places - with an underpinning principle of subsidiarity to enable tailored responses
  • that locally shaped solutions will progress at different paces - underpinned by commitment from all to make rapid progress

While the London partners are committed to progressing improvements as far and as fast as they can themselves, they have also sought devolution of functions, powers and resources from government and national bodies where this could unlock or accelerate progress.

London health and care devolution pilots

Five pilots are being established through which London partners will co-produce with national bodies and government the detailed cases for different aspects of devolution.  

The devolution agreements reached by pilots will be converted into contingent menus of devolution opportunities open to other localities and sub-regions across London.  All parts of London will therefore be developing their own plans for integrating and improving services and outcomes, with a view to being able to draw down on devolution to support their implementation. 

The five pilots are:

  1. sub-regional transformation:   Barking & Dagenham, Havering and Redbridge
  2. sub-regional estates:  Barnet, Camden, Enfield, Haringey and Islington ('North Central London')
  3. local integration: Hackney, Lewisham (2 pilots)
  4. prevention:  Haringey

A summary of each pilot can be found in the statements of support signed by pilot partners and appended to the London Health and Care Collaboration Agreement.

The government's health and care devolution agreement with London 

On the back of the London Health and Care Collaboration Agreement, this commits government and national bodies to working with London, including to co-produce suitable devolution responses to support and accelerate improvement of health and care. 

These commitments specifically cover exploring - primarily through the pilots:

  • aligning capital programmes and removing barriers to make best use of the NHS estate
  • flexibility and payment mechanisms and the provision of deficit funding to NHS providers
  • developing place-based provider regulation
  • workforce planning and delivery of education and training
  • devolving transformation funding
  • planning and licensing changes to support public health
  • joint working on employment and health.