Hackney Council have announced they will be part of a devolution of health and social care pilot, one of five London boroughs to take part in the pilot scheme.
Devolution of the health and social care services in Hackney has the potential to help tackle health inequality and poverty. It could bring decision making closer to Hackney residents and help to preserve the positive things that have been established so far. Devolution also has the potential to increase the integration of services. However, to do this effectively there are things that need to be addressed and questions still to be answered.
Hackney Council is currently organised under a cabinet model, which could be a block to the expression of local democracy - crucial to a successful devolution model. It is our belief that a return to a committee style of local government would allow a broader range of views to be expressed and better representation by local people. The current ‘first past the post’ voting system also reduces the representation by local people and doesn’t allow enough checks and balances within local government. Hackney Green Party would like to see Proportional Representation established for elections.
There are also questions about how the voice of the local community would be represented in a devolved health and social care system. There should be guarantees that the good practice of public involvement and participation, which has been established by the City & Hackney Clinical commissioning group, would be replicated by Hackney Council.
At present there is also a lack of information and understanding about how the outcomes from this pilot will be measured and the final responsibility for implementation. Who will hold Hackney’s devolved health and social care services to account?
It is unclear how this change will support the long term funding necessary for a sustainable health and social care service. The Green Party suggests an all-party funding agreement that will allow devolved health and social care bodies to plan and deliver for the long term needs of the local population in a joined up way. There is a danger in the devolution model of central government relinquishing responsibility, while at the same time not providing enough resources to meet local needs.
There doesn’t appear to be the option for a devolved model to take the market out of local healthcare if the local population wish. We believe that the market and private health/social care is not the best model and there should be the option within devolution for local areas to take the market out of their provision if they choose. Devolution of health and social care also has the potential to destabilise a truly National Health Service and this should be guarded against at a national level, but there doesn’t appear to be any provision for this at the present time.