Devolution of powers and funds from central government to local government has emerged as one of the Government’s flagship policies.

The Spending Review 2015 set out a clear commitment around furthering health and social care integration across the country by 2020. Devolution is seen an important enabler for this. It is one of a range of enablers leading to more place-based commissioning and joined up care pathways, designed to support and improve the integration of care for people, and empowering patients and local communities.

Devolution offers the potential for a stronger model of local shared accountability to underpin integrated commissioning and provision of health and care services across different delivery partners, not just statutory health and care services.

The Cities and Local Government Devolution Act 2016 enables the devolution of functions from national public authorities to local government, at the transferee’s request.  Other relevant provisions in the Devolution Act include changes to the NHS Act 2006, which enable better joint working or delegation of health functions across health bodies and local government.

In 2015, the Government invited local systems to submit devolution proposals ahead of the Spending Review.  A significant number of these include health within scope to varying degrees. NHS England is working closely with Government partners to understand and assess the benefits and impact of devolution proposals ahead of the implementation of any devolution deals.

What devolution means from an NHS England perspective

At the September 2015 Board meeting NHS England set out its position on devolution and agreed the principles and decision criteria that it will apply to any devolution proposals with health in scope.

In May 2016, NHS England published Devolution: What does it mean from an NHS England perspective?, which provides further information on how it will assess proposals for devolution of NHS England functions and how the devolution agenda links with the STP process. The document provides a useful framework for local systems as they develop their devolution proposals.

Next steps on devolution

In 2016/17, NHS England will be developing a more detailed framework to support local systems that are pursuing devolution to develop local devolution plans.  The more detailed framework will set out what is possible under the current legislative framework, including more information on what each model could mean for issues such as:

  • Governance, accountability, and assurance
  • Financial flows, where budgets could sit, how risk sharing might work
  • Workforce implications and organisation impact
  • Patient/public participation and consultation
  • Impact on other organisations
  • Impact of new policy announcements/direction of travel

Further information will be published on this page later this year.

Frequently Asked Questions

Local systems pursuing devolution of health functions should talk to their local NHS England Director of Commissioning Operations (DCO) in the first instance. Any national queries should be directed to Please also check the FAQs which we will be updating during 16/17.