Landmark devolution deal to improve health and care across the capital

16 November 2017
  • Devolution will bring health and care services closer together
  • The NHS in London will be incentivised to sell unused land and buildings, with money reinvested in health and care, community and public services
  • Surplus land will be available to develop more housing


A ground-breaking devolution deal that will lead to improvements in health and care in London has been signed by the Mayor of London, Secretary of State for Health Jeremy Hunt, London Councils and NHS, Public Health and wider health and care leaders.

The landmark agreement gives the Mayor, London Councils and health leaders more control over health and care in the capital, leading to more joined-up services for Londoners. The deal is the largest of its kind in England with over 100 organisations involved in shaping it over the past couple of years.

Localising decision-making to London through devolution will bring many improvements to health and care. It was hailed by Sadiq Khan today as “a really important step in the right direction in our journey to becoming the world’s healthiest city.”

The NHS is one of the largest owners of land and buildings in London: land it owns is up to three times the size of Hyde Park and has an estimated value of more than £11bn. Currently, a high proportion of London’s primary care estate – including GP surgeries and family health clinics - is in poor condition, with 13 per cent requiring rebuilding and 51 per cent in need of refurbishment1

Today’s announcement means that money from the sale of NHS-owned assets will be available for much-needed primary and community care and wider public services in the capital. The release of unused land will also create the opportunity to develop more housing.

A London Estates Board will bring together London and national partners to support the release of capital from surplus NHS estate and land to be reinvested in the city’s health and care system. This new way of working will speed up decision-making and ensure improvements happen much faster than the current five to 10-year average time to develop NHS estates.

Over the past two years, pilot projects across five areas in the capital2 have been exploring innovative ways of working across London’s large and complex health and care system – developing better and more efficient services that meet the needs of Londoners. Through their work, London has secured a number of powers which will help streamline care, improve services and drive prevention to the heart of local communities.

This deal brings health and social care services closer together, meaning that Londoners will experience more joined-up care that better meets their needs. This will help to overcome many of the barriers to health and care organisations working better together - such as around payments, regulation or workforce.

Improving London’s health inequalities is a major focus for the Mayor, with huge disparities in the quality of life across the capital caused by the differences in people’s homes, education and their childhood experiences, local environment, their jobs, access to public services and their habits. London is now in a stronger position than before to support Londoners to be as healthy as possible for as long as possible, taking more action to tackle the childhood obesity crisis and to significantly reduce health inequalities through a focus on the consumption of illegal tobacco and alcohol.

Mayor of London, Sadiq Khan, said: “I’ve long argued that London needs greater control over the services that will help improve life in our city. It is vital that the capital has the powers to plan and coordinate health services that meet the needs of local communities and ensure Londoners have proper access to them. Today is a really important step in the right direction in our journey to becoming the world’s healthiest city and an unprecedented level of partnership working, with more than 100 organisations, has made this all possible.”

Health Secretary, Jeremy Hunt MP, said: “This agreement will put local people in the driving seat about the health and care they receive in the capital and means that Londoners will have more of say on how their healthcare needs are met now and in the future.

“I know there is a huge amount of good practice and innovation in London’s health and care services, and this is will help them to go further and faster in improving patient care.”

Simon Stevens, NHS England Chief Executive, said: “This strengthened partnership has the potential to unlock funds for reinvestment in much needed modern NHS buildings and clinics across London, as well as kick starting more concerted action on rising health threats such as obesity and air pollution. The practical test will be ensuring this welcome new cooperation rapidly catalyses new benefits for all who depend on the capital's health services."

Cllr Claire Kober, Chair of London Councils, said: “Today marks a significant step forward for London. Through the work of the devolution pilots, the capital has demonstrated the clear benefits of partnership working at a local level to improve residents’ health.


“It is crystal clear from what we have learned from the devolution pilots that Londoners are crying out for a health and care system that ensures access to high-quality treatment when and where they need it, and enables them to live fulfilling and independent lives in their own homes, with access to community based preventative services. Devolving power locally, and building a real partnership between local government and the NHS, is the best way to deliver this.”

Professor Yvonne Doyle, Regional Director for London for Public Health England, said: “Today’s agreement is a major step forward in helping London to become a healthier place to live and work. Devolved powers will put prevention at the core of decision making. We want Londoners to live as well as possible for as long as possible.

“Health and care leaders across the capital have the option now to shape local environments and encourage healthy decisions and healthier lifestyles.”

Dr. Marc Rowland, Chair of the London Clinical Commissioning Council and Lewisham CCG said: “Today’s announcement paves the way for improving the health and ​wellbeing of over 8.6 million Londoners. It has been an exceptional journey of partnership working at local and London-level to get us to this milestone. Devolution provides the foundations to enable us to improve the way health and care services are delivered in the capital at a faster pace.

"Through the work of the pilots over the past year we have learned much more can be done to prevent ill-health, support people to make healthier choices and to join up health and care. Being able to reinvest money from selling NHS land and estate back into the capital is a huge step in helping to ensure buildings and primary care facilities are modern and more suitable for our patients.“

Professor Jane Cummings, Interim Regional Director, NHS England (London) and Chief Nurse for England, said: “London is the greatest capital city, with an ambition to be the world’s healthiest too.

“We’re already making progress towards this, but today’s historic Devolution deal will accelerate these efforts – giving London’s NHS and councils the freedoms and powers they need to provide the very best health and care services for the capital’s 8.6m residents.”

NHS Improvement’s Executive Director of Strategy, Ben Dyson said: “The launch of this MOU signals the strong commitment of health and local government partners in London to work together to transform the way that health and social care services are delivered across the city. We look forward to working with London Partners as they collaborate to make a better use of their shared resources to improve the quality of care and health and wellbeing of all Londoners”

Steve Russell, NHS Improvement’s Executive Regional Managing Director for London, said: “Partnership working between health and care commissioners and providers has already enabled the London system to make progress in delivering our shared vision of making London the healthiest global city, and today’s agreement marks a significant step forward on our collective journey. It is vital that transformation is locally led, and all partners are committed to working with health and care leaders and their teams to help shape and refine the delivery arrangements for London.”

ENDS

Notes to editors

The signed Memorandum of Understanding can be viewed here: https://www.london.gov.uk/sites/default/files/nhs_hlp_memorandum_of_understanding_report_2017.pdf

A summary of the devolution deal can be viewed here: https://www.london.gov.uk/sites/default/files/what_health_devolution_means_for_london_2017.pdf

The Parties to the devolution agreement are:

  • All 32 London Clinical Commissioning Groups (CCGs)
  • London Councils; 32 London boroughs and the City of London
  • Greater London Authority (GLA)
  • HM Treasury (HMT)
  • Department of Health (DH)
  • Community Health Partnerships (CHP)
  • NHS Property Services
  • Department for Communities and Local Government (DCLG)
  • Department for Work and Pensions (DWP)
  • Department for Culture, Media and Sport (DCMS)
  • Department for Education (DfE)
  • NHS Commissioning Board, Health Education England (HEE)
  • NHS Improvement
  • Cabinet Office
  • Care Quality Commission (CQC)
  • National Institute for Health and Care Excellence (NICE)
  • Public Health England (PHE)

1Better Health for London report: http://www.londonhealthcommission.org.uk/better-health-for-london/

2The five devolution pilot projects took place throughout 2016-17 in the following areas:

  • Haringey explored the use of flexibilities in existing planning and licensing powers to develop new approaches to public health issues
  • Barking & Dagenham, Havering and Redbridge explored integration, developing plans for an Accountable Care System, bringing primary and secondary care more closely together and patient pathways redesigned with a focus of early intervention and managing the chronically ill
  • North Central London (Barnet, Camden, Enfield, Haringey and Islington) focused on estates issues, testing new approaches to collaboration on asset use
  • Lewisham worked to integrate physical and mental health services alongside social care
  • Hackney developed health and social care integration plans working towards full integration of health and social care budgets and joint provision of services – with a particular focus on prevention