Skip to main content

Local and National: How the public wants the NHS to be both

OUTSIDE OF GREATER Manchester there has been very little public debate about healthcare devolution. So how does the public in England react to the idea of NHS
localism, in the absence of any significant national discussion? A Fabian Society opinion poll examined different dimensions of this question and revealed that handing power to local decision-makers could attract support, under the right conditions.

YouGov surveyed a sample of 1,405 adults living in England, with fieldwork undertaken between 13 and 14 October 2016 (the survey was carried out online and the figures have been weighted and are representative of all GB adults).

If you want to make any changes to the health system, perhaps the most crucial factor is to take people with you. Public opinion matters. Residents need to understand where they can receive services and what standards they can expect. Without patient support the system fails. This Fabian Society report is an important step in seeking to understand the real public attitudes to some of the changes which are currently being proposed.

Recent developments in England’s NHS, including the Five Year Forward View and innovation in vanguard areas, have set out the potential for communitydriven service transformation which better meets the needs of the people who live in those communities. In Manchester, in Cornwall and at borough level in London, diverse devolution plans are taking shape which have in common a desire to let neighbourhoods shape their own services around their own health and care needs.

How do we accommodate these changes within the framework of a universal national service, with national standards? Universal coverage must remain a priority. And we are still waiting to see what health devolution will mean for transparency in decisionmaking and for public understanding of the standards people can expect from the NHS. Too often devolution under the Cameron and May governments has meant localising blame and shifting responsibility for unpopular decisions. Accountability is key.

The sustainability and transformation plans (STPs) currently being drawn up across England have shown that health and social care leaders are prepared to be ambitious in redrawing services across sectors and across geographical boundaries, but the scale of change being proposed is not currently being matched by funding from national government. Service change at this scale requires investment and it needs to be front-loaded. It is not clear that the current government is prepared to pay for the changes local providers say are required. What’s more, if STP plans are merely about filling financial holes in government spending, they will neither command nor deserve the support of patients and their families.