In its Devolution White Paper published in December 2024 the Government set out its vision to create Strategic Authorities with control of a wide range of areas, including transport and local infrastructure, skills and employment support, housing and strategic planning, economic development and regeneration, environment and climate change, health, wellbeing and public service reform, and public safety. 

In terms of health, the document says the combined authorities are ‘designed to bolster' the roles of public bodies such as the NHS. 

The plans will see the absorption of district councils into larger combined authorities and also enable locally elected mayors to sit on the boards of Integrated Care Partnerships (ICPs). Buck said this was already happening in the case of the South Yorkshire combined authority where Mayor Oliver Coppard sits as a chair of the ICP. 

‘I think Integrated Care Systems will be more influenced by the new combined authorities,' Buck said. 

‘There will be more emphasis on coherence between local government, hopefully at a local authority level, not just combined authority level, and the relationship with the NHS.' 

The senior fellow said the changes would be unlikely to lead to major structural reform of Integrated Care Systems, however. 

Citing recent research by thinktank Reform, which argued that NHS England should be taken over by the DHSC, Buck said he could not see combined authorities taking greater control of healthcare. 

‘I don't think we will end up there, because the NHS is so big and so complex,' Buck argued. 

Similarly, the senior fellow said the possibility of combined authorities superseding Integrated Care Systems was a ‘very distant prospect both in time and in reality'.

‘I don't think combined authorities would be anywhere near ready to take control of the NHS,' added Buck, noting this would be the biggest reform since the NHS was founded in 1948i. 

He predicted a greater roll-out of innovation programmes such as the Health and Growth Accelerator programme which has been adopted in South Yorkshire, North East and North Cumbria, and West Yorkshire under the Get Britain Working White Paper. 

‘There's win-wins here for everybody,' Buck said. ‘There's going to be a much stronger connection between the combined authorities and the ICPs around economic activity.' 

Questions have been raised about the creation of larger combined authorities being contradictory to the Government's stated aim of greater local accountability. 

Buck said there was a logic to having a bigger footprint for larger areas of economic policy such as transport but did agree there was a risk of more power being sucked up from local government with the abolition of district councils and the challenge that creates about ‘closeness to the community and neighbourhood'. 

‘It could be contradictory but I think it depends on what issues, what powers and what decision making rests at each level,' Buck said. 

In addition, the senior fellow said major challenges lay ahead on maintaining cohesion between the DHSC's 10-Year Health Plan agenda and the health mission, the wider mission agenda and devolution, and the economic growth productivity agenda. 

‘They're all being led by different parts of Government at different speeds,' Buck noted. 

‘The challenge is, is Government actually aligned in terms of its policy thinking or are all these conversations happening separately?'

There is no clearly lack of ambition in the scale of the Government's reform agenda on devolution and the NHS but time will tell whether this will result in a more integrated healthcare system. 

Source: i The latest proposals on health devolution: solution or provocation?, The King's Fund, 18 April 2024.