English devolution white paper: what you need to know

Background

Devolution in England is the delegation of powers, programmes and funding from national government in Westminster, to local government. While the Greater London Authority was created back in 2000 comprising the Mayor of London and the London Assembly, the process of English devolution in the current context began in earnest in 2014, when the coalition government signed a deal with the Greater Manchester Combined Authority. 

Now, a decade later and with over 60 per cent of the population of England covered by a devolution deal, the new government has published the English devolution white paper, setting out a more standardised direction of travel. This white paper aims to help reset the relationship with local and regional government, empower local leaders and mayors to make the right decisions for their communities, and work together to grow an inclusive economy, reform public services and secure better outcomes. 

As the NHS Confederation set out in its May 2024 report, Prevention, Prosperity and Population Health: A New Era in Devolution, there are growing parallels between local government devolution and integrated care systems (ICSs), in terms of a genuine and shared interest in geography, place, role, purpose and outcomes. It is important that ICS and NHS leaders are aware of the proposals in the white paper and what they might mean for them and their communities, and are engaged in local discussions about emerging developments in their area.

Overview

The new devolution architecture 

The government believes that the creation of strategic authorities is vital to ‘complete the map’ in English devolution. There will be three levels of strategic authority which will hold varying degrees of power depending on their maturity and whether they have a mayor with the goal of having areas rapidly progressing along them. The white paper makes clear the major benefits of having an elected mayor. Underpinning these new strategic authorities will be forums to bring together their leaders; an updated devolution framework setting out their areas of competence; integrated settlements with an associated outcome framework; local government reorganisation and funding changes; and a greater ability for communities to be involved in developments. Together it is hoped this approach will end the ad hoc and inconsistent devolution journey and drive economic growth, more joined-up delivery of public services and improved community trust and engagement.  

Types of strategic authorities: 

• Foundational strategic authorities (FSA) - these are non-mayoral combined authorities or combined county authorities. While still receiving some new powers over transport, climate and skills, they are limited compared to areas with mayors. 
• Mayoral strategic authorities (MSA) - Combined authorities or combined county authorities led by a directly elected mayor. The increase in power over transport, housing, skills, regeneration, public safety and health, is in line with the government’s explicit desire to see directly elected mayors across all of England. 
• Established mayoral strategic authorities (EMSA)– Combined authorities or combined county authorities that have been led by a directly elected mayor for over 18 months. EMSAs have access to a multi-departmental, long-term integrated funding settlement and the ability to request the devolution of additional powers.

Health, wellbeing and public service reform

While many of the listed areas of competence for strategic authorities are consistent with previous devolution deals, the inclusion of health, wellbeing and public service reform highlights the key role of strategic authorities in addressing the social determinants of health and moving to a more holistic approach, organised around service users. The white paper supports this role in the following ways:

• Introduces a new bespoke duty in relation to health improvement and health inequalities, complementing the existing health improvement duty held by upper-tier local authorities. The government will engage strategic authorities, local authorities and the NHS in taking this forward.
• Recognises the benefits that aligned geographical boundaries can have for improving coordination between public services, including health services, and states that the government will work with stakeholders to identify areas where alignment and closer working can be facilitated. This will initially focus on where there is a clear rationale for doing so and where the benefits in aligning geographical boundaries significantly exceed any costs and risks incurred. It is worth noting that devolution footprints have long been based on functional economic areas that typically cover travel-to-work patterns and local labour markets. 
• Sets out an expectation that mayors (or a delegate) will be appointed to one or more relevant integrated care partnerships (ICP) in their local area. There will also be an expectation that the mayor (or a delegate) is considered for the position of chair or co-chair of the ICP, and that integrated care boards (ICBs) will engage with mayors during the ICB chair appointment process and will involve them in setting their priorities and developing their plans.
• Recognises that strategic authorities will need appropriate powers and levers to maximise their impact on public health and the government’s health and growth missions, and will keep their remit in this area under review.

The table below sets out the devolution framework’s differing levels relating specifically to health. It should be noted the devolution framework will be regularly updated.

Other areas of relevance

The white paper is wide ranging in its aims and detail. As well as the above aspects specifically referring to health, a number of other areas are relevant to members:

• At the more local level, the government expects all two-tier areas and smaller or failing unitaries to develop proposals for reorganisation. The ambition is to deliver the ‘first wave of re-organisation’ by the end of this parliament. The government is clear that they are willing to use ministerial directives to forcibly bring about changes if necessary. These unitary authorities will focus on delivering services, with the intention to serve populations of more than or equal to 0.5 million people.
• While mayoral elections are already scheduled for May 2025 in two areas, the white paper outlines a new ‘devolution priority programme’ which will fast-track more areas that meet criteria to have mayoral elections from May 2026. Which areas are included in this programme will be announced soon. 
• The government will create a statutory requirement for all mayoral strategic authorities to produce a local growth plan, setting out a long-term vision for growth in their region over the next decade and a roadmap for how this can be achieved. Foundation strategic authorities will instead set out a vision for growth in their area, building on existing local economic strategies where these exist. These plans and visions will certainly look to build on local health and anchor strategies.
• Strategic authorities will take on several existing and relevant responsibilities and/or funding programmes. These include joint ownership of the local skills employment plans (LSIPs) and the growth hubs, while the Long-Term Plan for Towns will be reformed into a new regeneration programme.
• Established mayoral strategic authorities will be able to propose, individually or with others, additional functions to be added to the statutory devolution framework or piloted locally. This is part of helping reframe the national/local relationship, which will also see strategic authorities seen as the default delivery institutions for new programmes or activity, with all arm’s-length bodies expected to have regard to their strategies.
• Three forums have been established to support this new way of working:
  • The Council of the Nations and Regions, chaired by the Prime Minister and which brings together First Ministers of the devolved governments, the deputy First Minister of Northern Ireland, and the mayors of strategic authorities to collaborate across the national missions.
  • The Mayoral Council, chaired by the Deputy Prime Minister and which brings together England’s mayors as the key forum for engagement between central government and mayors on Local Growth Plans, pushing on devolution, feeding back on how best to deliver on the ground, and identifying opportunities to better coordinate national and local policy. 
  • The Leaders Council, bringing together a representative group of local authority leaders with the Deputy Prime Minister and other ministers so that policy solutions can be co-designed with local government.
• The white paper states the government will implement a strengthened ‘right to buy’ assets of community value, creating a more robust pathway to local community asset ownership, and explore opportunities to work with local and strategic authorities to develop locally led approaches to public service reform, drawing together service providers in their areas to improve outcomes for residents. 
• The Office for Local Government will be closed, with the government intending to transform the audit system to give greater clarity on the purpose of audit and accounts, simplify the system, and ensure they take centre stage in local scrutiny.

Timeline 

The government’s ambition is for ‘universal coverage’ of strategic authorities in England, ideally by the end of this parliament. In addition to the existing 12 mayoral combined authorities, Greater Lincolnshire and Hull and East Yorkshire will elect mayors in 2025. The new devolution priority programme will see more mayors elected from 2026. Non-mayoral combined county council agreements with Devon and Torbay and Lancashire will also come into effect in 2025, while foundation non-mayoral single local authority devolution agreements are being progressed with Cornwall, Buckinghamshire, Warwickshire and Surrey. The replacement of local councils with larger unitary authorities will likely be a slower process, with only the ‘first wave of reorganisation’ occurring in this parliament. In its response to the white paper, the Local Government Association emphasised that ‘local government reorganisation should be a matter for councils and local areas to decide.’

Analysis 

The English Devolution White Paper builds on, and attempts to accelerate and standardise, the previous government’s commitment to spread devolution across England. This ambition of ‘completing the map’ is bold yet seen as vital in resolving the uneven governance patchwork experienced in England and in balancing inclusive economic growth with wider public service reform. 

Over the last decade we have seen much greater awareness of the value of health to the economy, and vice versa, and it is no surprise that the new white paper includes health, wellbeing and public service reform in the specific areas of competence strategic authorities can seek powers over. 

ICSs, themselves strikingly similar to strategic authorities in design, role and scale, will have much to offer and to gain from focusing, and partnering, on this agenda. Influencing the determinants of health over which strategic authorities exert direct control is vital in delivering against both the Secretary of State for Health and Social Care’s three priority shifts and the four purposes of an ICS. Both ICSs and strategic authorities will also share clear common interest in working together to support public service reform and prevention within places, while health will certainly form an explicit part of the Local Growth Plans as well as much of the other associated new statutory planning. 

The government clearly has a preference to align geography across public services and for an explicit role for the mayors on the ICP, again reiterating the value of this tier. At place level, it should be noted that the proposed speed and depth of devolution could lead to significant upheaval within local government partners, particularly in two-tier areas. 

Put simply, universal coverage of strategic authorities, delivering against a statutory framework and with broad integrated financial settlements, chart a new path in the sub-regional governance model of England, particularly given forthcoming work on scrutiny, accountability and outcomes. Much of our future funding and policy landscape will be collectively determined through these system structures and the NHS should play its part in this shared journey. 

Key actions for members

The health economic partnerships team at the NHS Confederation has played a leading role in supporting members on health and devolution, influencing national policy and supporting local partnerships. Our May 2024 report on health and devolution was intended to provide the necessary background to this issue in advance of a new government approach and we would recommend members read the report and get in touch to discuss in more detail. 

Depending on local circumstance, other key actions members can take include:

• engaging local authority leaders to determine appetite and plans for devolution, seeking to understand how they can support proposals
• discussing likely implications for joint local governance, including specifically place-level activity, the potential for the mayor to chair the ICP, and their role in ICB planning
• ensuring ongoing discussions about the ten-year health plan for the NHS involve local partners and have considered the role of strategic authorities in addressing the determinants of health.  
• influencing discussions about Local Growth Plans and visions for growth, including on work, health and skills, aligning these with ICSs’ fourth purpose and NHS anchor strategies.