The King’s Fund’s recent analysis of AndyBurnham’s vision for health and care devolutionhighlights a significant shift in the direction oftravel for public services. The ambition is clear:move power closer to communities, strengthenlocal decision-making, align public servicesaround place, all with the aim of creating greaterfocus on prevention and population health.
For NHS organisations, however, the conversationshould extend beyond governance reform. Thereal question now is not whether devolutionhappens, but how health systems prepare todeliver within a more localised operatingenvironment.
Drawing on our experience supporting NHSorganisations through transformation, we see fivekey questions leaders should be considering now.
1. Are We Organised Around Place, Or Around Institutions?
Devolution reinforces a place-based approachthat brings together health, local government,housing, transport and economic developmentaround shared priorities. Success will depend lesson individual organisational performance andmore on the ability of partners to achievecollective outcomes.
2. Can We Turn Prevention Into Delivery?
A central promise of devolution is greater focuson prevention and the wider determinants ofhealth. Yet prevention has often struggled tomove from strategic ambition to operationalreality. Organisations will need clear investmentdecisions, measurable outcomes and robustaccountability if prevention is to become morethan an aspiration.
3. Are Our Governance Models Fit For A More Collaborative Future?
As responsibilities become increasingly sharedacross systems and places, governancearrangements will need to evolve. Effective decision-making, aligned incentives andclear accountability across multiple organisationswill be critical to delivering meaningful change.The challenge will not be creating partnershipsbut ensuring they can make decisions andexecute effectively.
4. Do Resources And Capability Match The Responsibility Being Devolved?
Greater local control creates opportunity, but onlyif organisations have the flexibility, resources andcapability required to deliver. Experience fromprevious devolution initiatives demonstrates thelimitations of transferring responsibility withoutequivalent influence over funding, investment andresource allocation. Similarly, budgets andfunding models designed to allow a focus onmulti-year initiatives, rather than just in-year costsavings, will be required to enable meaningfulinvestment in locally relevant initiatives.
5. How Will We Measure Success?
Ultimately, devolution should not be judged bystructural reform alone. The true measure ofsuccess will be whether it improves outcomes forlocal populations, reduces health inequalities andcreates more responsive services. Thoseobjectives require disciplined execution as muchas policy ambition.
While many questions remain about the pace andscale of reform, the direction of travel isbecoming clearer. NHS organisations that beginpreparing now, strengthening partnerships,governance, commercial capability and deliverycapacity, will be best placed to succeed in a moredevolved healthcare landscape.
At 4C Associates, we believe the organisationsthat thrive will be those that view devolution notsimply as a policy change, but as an opportunityto rethink how services are designed andimproved for the communities they serve. Get in touch today.
