Government reforms signal shift towards more local health and care decision making

The UK Government has published its ‘Rewiring the State’ policy paper, setting out plans to reshape the structure of central government while devolving more decision-making to regional and local leaders. The reforms, which will be introduced over the course of this Parliament, are intended to create what the government describes as a stronger strategic centre while giving greater responsibility to local institutions for driving economic growth and public service delivery.

The proposals form part of the government’s wider ambition to devolve more decision making from central government to regional and local institutions. For organisations working across the health and care sector, the reforms could have important implications for how services are planned, funded, and influenced in the years ahead.

Changes to central government

Among the headline changes is the creation of No.10 North, which the government describes as the new “engine room” for devolution and local economic growth. A new Office for the Prime Minister and Cabinet (OPMC) will also bring together No.10, No.10 North, and core Cabinet Office functions supporting the Prime Minister and Cabinet.

Meanwhile, the Department for Business and Trade will be renamed the Department for Business, Innovation, Science and Trade (DBIST), with responsibility for science and innovation moving into the department. The existing Department for Science, Innovation and Technology (DSIT) will be dissolved, with its responsibilities redistributed across government to better align technology and innovation with wider economic and public service priorities.

Devolution and health system reform

For the health and care sector, the policy paper places significant emphasis on further devolution and place-based decision making. Central to these proposals is the government’s ambition to establish strategic authorities across England. These regional bodies are intended to make it easier to devolve powers from Westminster while bringing together responsibilities across areas including transport, housing, skills, economic development, health, wellbeing, and public service reform. They will complement, rather than replace, existing local councils.

As part of these reforms, Integrated Care Boards (ICBs) will be aligned with the boundaries of strategic authorities by the end of this Parliament. Where there are strong financial, strategic, or operational reasons, ICBs may instead align with the boundaries of multiple strategic authorities. The government says this will better align NHS planning with wider regional priorities and support more joined-up public service delivery.

The proposals also include greater alignment and pooling of funding for preventative services, with funding devolved, where possible, to enable strategic authorities and constituent local authorities to invest jointly in local priorities while continuing to meet national standards.

Changes to policy making

The policy paper also signals a change in how the government intends to develop policy. It proposes replacing the current model of “consultation by default” with new approaches to public participation, including reviewing where statutory consultation requirements could be removed and placing greater emphasis on engagement through local leaders and communities.

For organisations that routinely contribute to government consultations, these proposals could represent a significant change in how policy is influenced. While further detail is expected, businesses may increasingly need to engage through new forms of public participation, stronger relationships with regional and local leaders, and trade associations as routes for engaging with government, rather than relying solely on formal consultation exercises.

Looking ahead, the government has confirmed that, alongside this autumn’s Budget and fiscal devolution roadmap, it will publish a whitepaper setting out the full programme of reforms, including legislation, the alignment of public service boundaries, the transfer of additional powers and functions, and a timetable for implementation developed in partnership with mayors and local leaders. The whitepaper is expected to provide greater detail on how these reforms will be implemented and what they will mean for organisations operating across the health and care sector.