Designing health into devo bill

This article originally appeared in the Local Government Chronicle.

Our country faces deep and growing health challenges. But these are not simply problems for the NHS to solve. They are rooted in, and have consequences for, the wider economy and society.

Poor health is now one of the most fundamental constraints on the UK’s economic performance. Around 8.2 million working-age people in the UK report a long-term health condition that limits their ability to work at a cost to employers of up to £150bn a year. This is not a marginal issue.

The case for action is clear. Health outcomes in England vary sharply both between and within regions. Mortality rates are around 20% higher in the North East and North West than in the South West, reflecting deep and persistent regional divides. Inequalities are also pronounced within regions, with life expectancy gaps of over five years between local authorities operating within the same strategic authority.

For the government’s devolution agenda to unlock growth and improve public services, it must engage directly with the health of the population and with the local and regional bodies that shape the places where people live and work.

Devolution should give local leaders the tools to make a tangible difference to everyday life. But if poor health and widening health inequalities continue to constrain economic participation and public service effectiveness, and local growth plans are not used to drive better health, then devolved leaders will fail to deliver real change for their communities.

Targeted amendments

That is why the English Devolution & Community Empowerment Bill, currently going through the House of Lords, matters. It is a significant moment in the evolution of regional governance, with new powers and responsibilities moving to strategic authorities and an explicit expectation that devolution should support improved outcomes for communities, including health.

The question now is whether a responsibility for the factors that shape health is designed into strategic authorities in a way that enables them to make a real difference, while working effectively in partnership with councils and other local partners.

Alongside organisations including Health Equity North, the Health Devolution Commission, The King’s Fund and the NHS Confederation, we are arguing that the bill can be strengthened through a small number of targeted amendments to ensure strategic authorities have the tools they need to improve the health of the people they serve.

Health inequalities are not random. They reflect the places where people live their lives, shaped by local economies, housing, transport, environments and labour markets. National policy and funding remain essential, but on their own they cannot respond with sufficient precision to local context. This is where devolution can make a difference.

Implementation mechanisms

Strategic authorities, working in partnership with councils, can align economic development, regeneration, transport, housing and skills around shared local priorities, creating the conditions for more coordinated, preventive action. But this will only happen if improving health and reducing inequalities are explicit objectives, not secondary considerations.

The bill takes an important step in this direction. The inclusion of a duty to improve health and reduce health inequalities and the recognition of health as a core area of competence for strategic authorities, send an important signal about the government’s intent. As the minister responsible for the bill in the Commons, Miatta Fahnbulleh has acknowledged, tackling health inequalities and their determinants is rightly a key priority for regional government.

In many places, this agenda is already being taken seriously. Mayors and strategic authorities are embedding health considerations into economic and spatial strategies, convening partners and testing new approaches. The Health in All Policies toolkit, developed as part of the mayoral regions programme and funded by the Health Foundation, showcases how strategic authorities are building health considerations into decision-making across everything they do.

However, a health duty on its own does not guarantee action or consistency. Without clear mechanisms for implementation and accountability, there is a risk that health is prioritised unevenly, depending on local capacity, capability and political will. Over time, this could inadvertently widen health inequalities between places, as better-resourced and more established strategic authorities move faster than others.

Supporting local flexibility

The amendments we are proposing would require strategic authorities to produce a health inequalities strategy, align local growth plans with the statutory health duty, and introduce a reciprocal duty on local public service partners to cooperate. Together, these measures would strengthen accountability, improve coherence across policy areas and support whole-system action to improve health.

These proposals are deliberately light touch. They mirror what is already happening successfully in places such as London, avoid unnecessary bureaucracy or new spending commitments, and support rather than constrain local flexibility.

This is a rare moment to get the foundations of devolution right and to be clear about how success will be judged.

Health is not a competing priority to growth, but a precondition for it. Devolution will ultimately succeed or fail based on whether people see real improvements in their lives, including their health. Embedding health into the roles, responsibilities and accountabilities of strategic authorities from the outset ensures devolution delivers outcomes that matter to people and drives both stronger economic performance and real improvements to people’s lives.