Catch Up: We Need A Radical New Offer on Devolution
Reform: More Devolution is Needed
A radical new offer is needed. The devolution agenda in England should be drastically accelerated. Commissioners need the power to design contracts for providers to meet local needs most effectively – in healthcare, employment services, skills and offender management. This requires commissioners to hold non-ring-fenced budgets, with maximum freedom to design contracts to offer to competitive public-service markets. This will only flourish if commissioning areas are designed to cover geographies requiring similar interventions, and governed by single, integrated and accountable commissioning bodies.
This is more a change of tune than a tearing up of institutional arrangements. Unitary authorities or combined authorities can be responsible for commissioning services, totalling over £100 billion in 2016-17 spend. These would replace complex local commissioning bodies, such as Clinical Commissioning Groups (CCGs) and Police and Crime Commissioners (PCCs), and allow commissioners to integrate service design. New local authority structures can cover 38 areas, which have similar healthcare and employment needs. This transfer of funding from central to local government would be followed by the abolition of NHS England, a commissioning organisation. The centre must take a light-touch approach by setting high-level outcomes, for local commissioners to tailor to their areas. International moves to a more devolved state suggest this can be completed in 15 years, with the right support.
Recommendation 1: The Government should devolve 95 per cent of NHS England’s budget, totalling £101.9 billion in 2016-17. The Government should scrap NHS England.
Recommendation 2: The Government should devolve responsibility for the commissioning of five employment-services programmes, including Jobcentre Plus, totalling £1.5 billion in 2016-17.
Recommendation 3: Government should devolve the commissioning of 12 skills and apprenticeships programmes, totalling £3.2 billion in 2016-17.
Recommendation 4: Government should devolve the commissioning of probation and youth-justice services, totalling £1 billion in 2015-16.
Recommendation 5: Government and local areas should ensure the coterminosity of services boundaries when entering devolution negotiations. They should take into consideration population health outcomes, their wider determinants, LEP boundaries, STP boundaries and council boundaries. Taking these elements into account would approximately result in 38 devolved commissioning areas.
Recommendation 6: A combined authority or a unitary authority should cover a commissioning area and take on all devolved commissioning functions for healthcare, employment services, skills and apprenticeships, and offender management.
Recommendation 7: Local commissioning boards should be headed by a single leader accountable for these decisions. Mayors should not be mandated by central government, however, and local areas should be able to shape their own leadership structure if one elected official holds a time-limited position accountable for public services across the local commissioning region.
Recommendation 8: Local commissioning bodies should form around the outcomes set by the cabinet and leader. Agile procurement teams should tender contracts, and disband after.
Recommendation 9: The Government should expand the role of the Cities and Local Growth Unit to include oversight of the devolution of public-services commissioning. The new unit should be called the Devolution Unit with wider membership from all departments from which powers are devolved.
Recommendation 10: Local commissioning bodies should receive block-grant funding. Local commissioning bodies should only be required to meet high-level outcomes agreed with the centre to receive the funds, and the grants should cover five-year periods. Block grants should be inflation linked and the inflation index and funding formula set by a UK Funding Commission.
Policy Exchange: More Research and Development in International Aid
The UK should double the proportion of its international aid budget spent on research and development in order to solve the most pressing global challenges and support the Government’s Industrial Strategy, says Policy Exchange in a new report. In 2015, British aid for R&D amounted to £419 million; over the medium term we should increase this both to help the poorest people in the world and to support the UK’s world leading scientists.
Growing drug resistance, increasing demand for clean energy and rising global food demand are among the challenges British science can help tackle. Yet R&D is relatively neglected by the rest of the international development community, presents high returns compared to other forms of intervention and is a British strength.
Policy Exchange worked with the Copenhagen Consensus Center to analyse the benefits of nearly 40 potential R&D projects which will help meet the UN’s Sustainable Development Goals. Among the most effective areas where British science could save and improve lives, and where we should invest our R&D money, are:
Developing affordable treatment for asthma.
Cheaper home monitoring and drug delivery for HIV/AIDs.
Developing a long acting reversible contraceptive.
Expanding the potential for irrigation in Sub-Saharan Africa.
Developing and promoting cleaner cookstoves
New Economics Foundation: Communities Groups Can Provide Genuine Affordable Housing
We recently launched our public land map, which helps to expose the government’s under-the-radar land sale. Today we want to talk about something more positive: the alternative to public land sales. Across the country, community groups have sprung up to take control of housing in their local area. As well as challenging land sales, these groups are putting forward their own development plans and working to build community-led housing on public land.
In North London, StART Haringey aims to build 800 homes on a former hospital site, three quarters of which will be genuinely affordable to local residents. The campaign was prompted by anger over the original developer’s plans for the site, which contained just 14% affordable homes. NEF has been working to support StART Haringey in its bid to acquire and develop the site, and build genuinely affordable homes.
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