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The Local Health Service?: How to balance local control and national standards in access to health care

Getting the balance right between national, local and frontline control of our health service is crucial.


The balance between national, local and frontline control in determining access to healthcare is a critical issue for the NHS. People usually think of health as a national service, but clinicians’ expert judgement and local level commissioning decisions have always played a vital role in determining access to healthcare in England.

This report explores how to get the balance right. How local should our National Health Service be? With the devolution of the £6bn health and social care budget to Greater Manchester, this question sits atop the political agenda in a new parliament. Described by Simon Stevens of NHS England as “the greatest integration and devolution of care since the creation of the NHS in 1948”, there is clearly huge potential here to take a system-wide, ‘whole-area’ view on public health, focusing on keeping people healthy; and to pool resources and drive the efficiencies the health service is going to need in the face of increasing pressure. But huge practical, budgetary and democratic questions remain unanswered.

This report considers how greater control for services users, employees and local leaders can be delivered alongside higher performance and value for money.

With David Buck (the Kings’ Fund), Dr Clare Gerada (former chair of the RCGP), Andrew Harrop (Fabian Society), Dr Steve Kell (NHS Clinical Commissioners), Rudolf Klein (British Academy), Michael Macdonnell (NHS England), Daisy-Rose Srblin (Fabian Society), Dr Howard Stoate (Bexley CCG and form Labour MP), Jessica Studdert (Local Government Association), Laura Wilkes (NLGN)









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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.

Greater Manchester's mission

1 April 2016

Integration. prevention. personalisation. The buzzwords that indicate the reforms our health and care system needs are as widely recognised as they are overused. So too are the problematic features of current service provision: fragmentation, barriers and silos. The challenge is...

Continue reading Devolution / Facing the Future / Health / Public Services


Ed Wallis

Ed Wallis is policy manager at Locality. He was previously editor of the Fabian Review.

Anya Pearson

Anya Pearson is a former assistant editor at the Fabian Society.


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