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Catalyst or distraction? The evolution of devolution in the English NHS

‘Devolution’ – the transfer of power from a higher to a lower level of government – is high on the political agenda in England, and looks likely to remain so for the course of this parliament at least. While the recent interest in devolution within England has not specifically focused on health care, it has been caught in its wake. In 2015, five Devolution Deals* that included aspects of health care were agreed. Another three Deals that included reference to health were announced in the 2016 Budget.† By far the largest of the agreed Deals is with the Greater Manchester Combined Authority.

This report considers the potential implications for health and care outcomes of health care devolution in England and how policy could best evolve. While the wider devolution agenda includes many public services, which could all have an impact on health outcomes, the focus of this report is primarily on devolution in the NHS. It draws on analysis of the Devolution Deals agreed to date, relevant literature, and international experience with a focus on four European decentralised
health systems.