Devo-Then, Devo-Now: What can the history of the NHS tell us about localism and devolution in health and care?

Article

Over the past few decades a recurrent theme in public policy discourse has been the desire to decentralise economic, public service and democratic power within the UK, and more recently within England.

These initiatives – and in particular the devo-health ‘experiment’ in Greater Manchester – throw up a range of questions for policy makers and the public. How much power should be passed down to the local level within health and care? Who should they be passed down to? What should local leaders do with these new freedoms? Will this process lead to the democratisation of health and care decisions and speed up reform? Or, will it hinder the ability to deliver an efficient and effective health and care system?

Over the last year or so, IPPR has been looking to answer these questions from a contemporary perspective. However, we also recognise that historians of the British health system will likely feel a sense of déjà vu as they look at these developments. For questions of how to reconcile the goals of a national service (fairness, efficient use of resources) with the benefits of devolved powers (democratic control, community integration) are not new. Indeed, they go right back to the creation of NHS in 1948.

It is our hope that this set of essays, authored by leading historians of both the health and care system and the decentralisation of public services, will help shed light on some of the debates, feeding into the ongoing discussions at national and local level about the role of localism and centralisation within health and care. We hope you find them both interesting and informative.

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