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Devolution is one of the three ways that the Government is introducing integrated health and social care at a local level in England. If you are a member of nursing staff working in England, it is important to know how devolution might impact you and your patients. 

What is devolution?

Devolution is about moving more power, and responsibility, down to regional and local government; and in some cases to NHS organisations such as Clinical Commissioning Groups (CCGs). 

Through the Cities and Local Government Devolution Act 2016, decision making and service provision across a wide range of areas from health and social care to transport can now be done at a local level.

The Government believes that this will foster and support better integration across services, and encourage efficiencies and savings by permitting regions or city-regions to manage their own finances. 

Devolution passes responsibility for funding from central government and this will also include any funding cuts.

Where devolution is happening

Devolution will be taking place across all of England. Regional information is available here:  

South East England
South West England
Eastern England
East Midlands
West Midlands
North West England

Information on developments in other regions of England will be available here soon.

How devolution will impact nursing staff

This is a rapidly changing policy area, and so it is hard to be specific.

However, there are two big issues that we are monitoring: funding, and roles.   

If devolution is used to reduce the overall funding for health and care services, then there could be reductions in overall or specific staff numbers, reductions in training places, or amendments to pay arrangements at the local level. This could include changes to staff contracts and terms and conditions and an increase in TUPE transfers. 

There is also speculative talk of a new workforce with new roles which could impact on the future shape of nursing.  

How devolution will impact patients

Removing barriers between health and social care services could be good for patients. But if this is at the expense of NHS budgets it could reduce service provision or access.

Devolution will allow local authorities to commission services on a greater scale, which may lead to the loss of smaller, more bespoke services. It will be up to health and care commissioners to ensure that this doesn’t happen. 

How nursing staff can influence devolution

Clinical leadership will be key in developing solutions for devolving health and social care.

It’s vital that senior nurses and clinicians are involved in all decisions about service and delivery from the outset of a devolution deal being proposed through to its implementation.  

In devolved areas there will be stakeholder events, often advertised on the local authority websites. These events would be a good place for you to raise any suggestions and concerns that you might have. 

You can contact your local RCN regional offices for more information.

Integrated care in England

Find out more about the three ways integrated health and social care is set to be delivered in England and what it all means for you.