Agenda item

To consider the update on devolution to London.

5.1       Ezra Wallace (Head of Corporate Strategy) presented the report and advised that there was likely to be some movement in devolution following the Government’s Spending Review and Autumn Statement on 25 November. The Government had invited London Councils and the Mayor of London to submit a single document on their Devolution and Public Service Reform proposition and this had been duly submitted to the Government on 4 September. Ezra Wallace stated that there was still a need for further consideration on what London could do to accelerate devolution. It was possible that the Government would announce some pilot devolution schemes in the future. Ezra Wallace added that the Board needed to consider its role in terms of system leadership which would be even more important under devolution, and to set out its priorities.

5.2       Members noted that the Board had discussed system leadership and its’ ‘asks’ in May and had identified that its views were in line with other London health and wellbeing boards. The Board had concurred that it desired greater leverage in order to ensure services worked in the way it wished. It was commented that some interesting opportunities would arise if the Health Education Fund was devolved locally, especially as local authorities, CCGs and the Board had a greater understanding of the workforce it needed. It was also commented that workforce needs would also tie in with the need for sufficient affordable housing. A Member stated that part of the debate around devolution centred on partner organisations working with hospitals with regard to patient discharge and working on accountable care. Another Member emphasised the need to wrest local control of assets and control of NHS estates would also be desirable. She stated that at a recent Providers Network meeting, concerns had been expressed about whether there would be sufficient funding to operate services locally in an effective way, particularly in respect of older people pathways. Strong relationships and an organic way of thinking would also play an important role in getting the best out of pathways.  A Member asked whether NHS estates would come under the public realm or would there be a risk that they would be sold off privately. She added that she had heard that it may take up to five years to take control of the estates.

5.3       Matthew Bazeley (Managing Director, NHS Central London Clinical Commissioning Group) referred to the vacant Samaritan Hospital site that had been sold with the receipts going to the Government treasury. Under the current arrangements, the NHS could not be certain that it would receive any return from the sale. However, devolution would present the opportunity to reset some of the rules with regard to estate allocation, whilst there were already a considerable number of local powers that could be used to control estates and other assets. Matthew Bazeley also stressed the importance of strong relationships and partner organisations working closely together, whilst there should not be an excessive focus on policy.

5.4       The Board expressed its hope that devolution would allow for strengthening of local ways of working, including greater control over estates and providing levers to enforce the Board’s wishes in ways of working. Members also emphasised the importance of locally devolving the Health Education Trust in order to help deliver the workforce it needed.