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Surrey health devo could be big, but little is yet known

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Commentary on a significant development in health in Surrey

The chief executive of NHS England Simon Stevens described the Surrey Heartlands health devolution pledge, announced yesterday, as “groundbreaking”.

His counterpart at NHS Improvement, Jim Mackay, said the agreement was an “exciting” form of health and social care integration that “makes better use of the collective funding and resources across the NHS and local government”.

Health secretary Jeremy Hunt and chancellor Philip Hammond will also no doubt be delighted that this momentous event has taken place in their constituencies.

The fanfare with which the agreement between Surrey CC and Guildford & Waverley, North West Surrey and Surrey Downs clinical commissioning groups was announced suggests a landmark moment and potentially the biggest development in health and social care delivery since Greater Manchester was given control of its entire health budget.

But how is this all going to work? With all the superlatives used by NHS big-hitters, something important must be happening surely, but what it is exactly?

Unfortunately, after an assessment of readily available information it is currently difficult to tell.

The press release mentions an agreed “roadmap towards devolution”, but offers no detail on what will happen and when.

It promises “more local accountability” for health budget spending, but no insight into how this will be achieved, not least when the area covered by the devo deal only takes in three of Surrey’s five CCGs, meaning it is not coterminous with the county council.

The agreement, we are told, “signals the beginning of a longer journey with an intention to “accelerate” integration through “closer working”, secure greater public engagement and increase local decision-making and flexibilities to achieve the best possible outcomes”.

These are simply the same aspirations that preoccupy councils and health bodies across the country, who are achieving varying degrees of success in the face of complex financial and cultural challenges.

Despite a lack of available substance to the worthy concept, the agreement could still prove to be significant for the people of Surrey and local government in general.

A genuinely new approach with approved, significant local freedoms would offer hope that central government, despite its immediate and escalating challenges, is willing to relinquish control and free up resources for locally-led solutions to pressing problems.

But the Surrey Heartlands agreement currently poses more questions than it answers.

What are the planned commissioning arrangements? How will the finances work and what role will Surrey CC have within the governance arrangements? 

The STP process has been frequently criticised for failing to engage effectively with councils and communities, giving rise to claims of secrecy and behind-closed-door deals.

Surrey CC leader David Hodge (Con) has been notoriously at pains to stress the financial challenges facing social care services in Surrey, but he was conspicuous by his absence from the announcement of a deal that could have the potential to relieve some of these pressures.

In an email to LGC, Helyn Clack (Con), Surrey CC cabinet member for health, said she was “delighted” to see “alignment emerging from the work of the better care fund and the health and wellbeing board in Surrey”, but suggested council officers could provide the “operational detail”.

This was an opportunity to not only shout about progress being made to tackle one of the great challenges of our time, but also offer hope to those seeking light at the end of the social care tunnel.

But a lack of detail and therefore insight into the implications of the deal means we must for now remain in the dark.

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