Renaisi recently conducted a short evidence review for SCIE of the health and social care devolution pilots that are currently taking place in London. The five pilots have the overall aim of improving the health and wellbeing of Londoners, in the context of needing to shift from reactive care to prevention, early intervention and sustaining people’s independence. They are testing different ideas and powers that could be scaled up in the future.
I stumbled across two pieces online this week which provoked some thoughts about the role of service users and the public in devolution plans. Involve argue that devolution ‘presents a real opportunity for councils to reconfigure the relationship between citizens and renew public interest in local government’. A review by NEF draws attention to democracy being the ‘missing link’ in the devolution debate, with a far greater emphasis in deals on economic growth. They call for mechanisms for residents to participate in decision-making around local devolution agreements and hold the deals to account.
Both of these insights were written in the context of devolution deals (rather than just health and social care devolution). However, in our review, we did explore what local engagement was taking place around the London devolution plans. The pilot areas had recognised the importance of creating opportunities for anyone interested to help shape future pathways and services, and conversations were generally taking place through existing patient and user forums.
However, it was also clear that engaging local people around health and social care devolution was a challenge:
- Does health and social care devolution (which risks being quite technical in terms of talking about system wide changes) have any resonance with residents in a local area?
- Is it possible to explain the benefits clearly – in a way that highlights the improvements in health and wellbeing outcomes that the pilots are seeking?
- Is there a risk of either raising expectations or failing to be transparent enough given the pilots are at a developmental stage?
A lot of these questions involve rewinding to carefully consider the scope and purpose of engaging residents – is it about identifying and prioritising needs or directly informing decision-making? It is undoubtedly easier to engage local residents on the wider devolution deals which involve far more local services than just health and social care. For example, in Greater Manchester, devolution was framed as raising public expectations of services delivering better outcomes for local communities, rather than seeing devolution as an end in itself.
The health and social care devolution pilots are about making sure ‘health and care decisions are made for London, in London’. These are potentially bold plans and ambitions, and discussions with residents need to be ongoing and accessible, finding creative ways to spark people’s interest about the possibilities that might lie ahead – however procedural or remote they might seem at this stage. I’m interested in thinking more about what that ‘hook’ might be.
it is increasingly important to ask how devolved powers play a role in democratic renewal more generally, and to ensure that arrangements for these support a growing appetite for engagement and conversation between the electorate and their representatives.