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Local and National: How the public wants the NHS to be both

Fabian Society research looks at what the public thinks about health devolution - and what more politicians and the NHS should do in response.


It is early days for the devolution of healthcare, but NHS localism has the potential to transform how public services are delivered in England. It offers the opportunity to make the NHS – a cherished 20th century institution – fit for the 21st century: responsive to local variation, accountable to communities and working to promote good health and wellbeing. Devolution to cities and counties also has the potential to speak to our political moment, by making manifest the public’s desire to take back control.

Yet Fabian Society research conducted for this report shows that while people may have heard the term ‘devolution’, there is virtually no public understanding of what it entails. And while people believe that local control will improve healthcare and welcome public participation in NHS decisions, they are also deeply committed to the principle that healthcare entitlements and standards should not vary from place to place.

This report includes analysis of the research findings, and reports on the first experiments in NHS devolution, along with calls from authors for greater public accountability and involvement. Contributors include shadow health secretary Jon Ashworth MP, Lisa Nandy MP, Lord Smith and key NHS leaders from Greater Manchester, London and Cornwall.

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How to purchase

Copies are available priced £4.95 from the Fabian Society bookshop – call 020 7227 4900, email or send a cheque payable to “The Fabian Society” to 61 Petty France, London, SW1H 9EU.


Andrew Harrop

Andrew Harrop is general secretary of the Fabian Society.


Tobias Phibbs

Tobias Phibbs is a researcher at the Fabian Society.

Tara Paterson

Tara Paterson is a member of Canada’s New Democratic Party – the social democratic party that sits to the left of the centrist Liberal Party. She previously worked as a researcher at the Fabian Society.


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