The full devolution of responsibility for health and social care budgets and services has happened in only one area – Greater Manchester. But two of the six other Metro Mayor areas – Cambridgeshire and Peterborough, and Liverpool City Region – have responsibility for the planning of health and social care integration.
This reflects a cautious approach to a clearly daunting task, but the quiet ‘health devolution’ revolution that is shifting the geography of power in the NHS through the Metro Mayors, new area-based Integrated Care Systems and the Sustainable and Transformation Partnerships is being watched with keen interest by health and social care policymakers at every level.
Can health devolution overcome the twin challenge of integrating two mutually-dependent services delivered by two separate organisations and funded in two fundamentally different ways? Or more fundamentally, can real integration of health and social care ever happen without devolution? Could Greater Manchester be the model for the future of integrated health and social care systems throughout the country?
The new name of the Department for Health and Social Care, the promised reform of social care funding and the public commitment to a substantial financial settlement for the NHS suggests there may be some radical changes to come this year. Health devolution to Metro Mayors or other local structures could be a key part of that change, ensuring we have a sustainable and high quality health and care system for the future.