Health Devolution Commission

Sharing social enterprise perspectives with the Health Devolution Commission

We are pleased to be supporting the Health Devolution Commission; a piece of thought leadership work in which five former health ministers (along with other senior figures from the health and social care world) are holding an independent cross party inquiry into the value and accountability of devolved health systems.

Health devolution is seen as one approach to place-based health service reform that has the potential to integrate not just disparate services within the NHS, and NHS and social care services in a locality, but to bring together in a combined strategy and structure all of the services and systems within a community that have an impact upon the health of a local population. Therefore, it may provide the means to better meet their health and care needs.

To support the engagement of social enterprise providers in the Commission, we are facilitating opportunities for our social enterprise network to share evidence. We hosted an online discussion group, which provided useful and interesting insights:

  1. Social enterprises (SEs) have freedoms and flexibility that statutory providers don’t, so they can be more agile and responsive to local needs in devolved areas. This feature is vital to the success of health devolution so SEs need to be fully engaged as partners in devolved structures. At present SEs are not even at the table – to their own detriment but also to the detriment of health devolution itself.
  2. The process of health devolution should include design principles of co-production and co-design in the shaping of the devolved system. This includes providers collaborating together to deliver better services locally; and commissioners avoiding using their devolved freedoms and powers to unnecessarily create new organisations and thereby undermining existing social enterprise providers.
  3. Health devolution must embrace community health improvement, particularly improving housing quality, which can be a major driver of physical ill-health and lead to mental ill-health as well.
  4. There is a chasm at national and local levels between health policy and strategies on the one hand and economic development policy and strategy on the other hand. The social enterprise organisational form embraces organisations in both spheres, so SE networks could play a useful role in promoting a ‘health and prosperity’ way of thinking to move forward from the existing siloed ‘treatment’ and ‘integration’ paradigms hat currently underpin most health thinking.
  5. The post Covid-19 exit strategy needs to avoid a ‘return to normal’ approach, and take it as an opportunity to re-shape policy and strategy around the ‘health and prosperity’ paradigm that could be delivered in part through the implementation of a comprehensive approach to health devolution.

Thanks to those who took part in the focus group. Further contributions are welcomed by the Commission – you can find out more and share your views at