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.

A recent House of Lords debate on the English Devolution and Community Empowerment Bill has highlighted long-standing challenges in wheelchair and community equipment provision — and how a proposed amendment could help address them.

The amendment

Amendment 165A to Clause 44 of the Bill, tabled by Lord Hunt of Kings Heath, would add the following to the list of “general health determinants” that authorities must consider when addressing health inequalities:

“(f) the degree of ease or difficulty with which persons have access to high quality wheelchair and community equipment provision.”

This amendment would include wheelchair and community equipment provision in the list of ‘general health determinants’ that authorities need to have regard to as a cause of health inequality.

Debate highlights

Peers from across the House voiced support for the amendment, describing the current state of wheelchair and community equipment provision as fragmented, inconsistent, and underfunded.

Watch the debate from 19:56:28 via this link: https://parliamentlive.tv/event/index/dacc4873-aaf6-4230-83a1-46ad665ad36b?in=19:56:28

Lord Hunt of Kings Heath called the current system “a disgrace,” citing evidence from the Wheelchair Alliance and the All-Party Parliamentary Group for Access to Disability Equipment showing the lack of national standards, independent regulation, and clear repair or complaints processes. “Many disabled people face long waiting times, delays in hospital discharge, loss of independence, social isolation and avoidable deterioration in health and well-being,” he said.

He explained that wheelchair and community equipment services, though often reaching the same individuals, are managed separately — one primarily by the NHS, the other by local authorities and integrated care boards. This division, he argued, leads to inefficiency and poor outcomes. “They should operate in tandem, but they are two distinct systems,” he said, urging closer collaboration.

Lord Shinkwin, speaking as a wheelchair user, said the amendment “puts the issue on the radar,” adding that access to wheelchair and community equipment services “is a health inequality issue.” He warned that the system’s fragmentation and lack of accountability have allowed inequality to become normalised. “Fragmentation may make for better ICB balance sheets in the short term, but history shows that, in the medium term, it is a very costly false economy.”

Baroness Griffin of Princethorpe added that one in three disabled people are still waiting for approved equipment, and that 74 percent of delayed hospital discharges are linked to equipment delays. The amendment, she said, would help make this area of provision a recognised factor in tackling health inequalities.

Government response

Responding for the UK Government, Baroness Taylor of Stevenage acknowledged the concerns but said existing legislation already requires provision of such services. In her response in the House of Lords, she said:

“Local authorities in England already have a statutory duty under various legislation, including the Care Act 2014 and the Children and Families Act 2014, to make arrangements for the provision of disability aids and community equipment to meet the assessed eligible needs of individuals who are resident in their area. In terms of delivery, NHS England supports integrated care boards and wheelchair providers to reduce regional variation in the quality and provision of NHS wheelchairs and to reduce delays in people receiving timely intervention and wheelchair equipment.”

She added that she would raise the issues with colleagues in DHSC and MHCLG and confirmed that the Bill’s existing scope already allows for access to equipment to be considered under “general health determinants.”

Watch Baroness Taylor’s response to Amendment 165A from 16:06:27 via this link: https://parliamentlive.tv/event/index/49b1e807-8829-4a75-a307-4a738052e65b?in=16:06:27

What it could mean for BHTA members

If accepted, Amendment 165A would:

• Formally recognise wheelchair and community equipment provision as a determinant of health.
• Require authorities to show how they are addressing access and quality of provision.
• Potentially influence commissioning priorities and encourage more consistent service standards.

Next steps

The amendment remains under consideration as the Bill progresses through the House of Lords. Its debate marks an important acknowledgment of the essential role that wheelchairs and community equipment play in tackling health inequalities. The BHTA will update members if the amendment is accepted into the Bill.