This report makes 10 recommendations for improving public services commissioning. It argues that commissioning of over £100 billion of public services spend, including 95 per cent of the NHS budget, could be devolved to around 38 regions and could deliver better outcomes at a lower cost:
Recommendation 1: The Government should devolve 95 per cent of NHS England’s budget, totalling £101.9 billion in 2016-17. The Government should scrap NHS England.
Recommendation 2: The Government should devolve responsibility for the commissioning of five employment-services programmes, including Jobcentre Plus, totalling £1.5 billion in 2016-17.
Recommendation 3: Government should devolve the commissioning of 12 skills and apprenticeships programmes, totalling £3.2 billion in 2016-17.
Recommendation 4: Government should devolve the commissioning of probation and youth-justice services, totalling £1 billion in 2015-16.
Recommendation 5: Government and local areas should ensure the coterminosity of services boundaries when entering devolution negotiations. They should take into consideration population health outcomes, their wider determinants, LEP boundaries, STP boundaries and council boundaries. Taking these elements into account would approximately result in 38 devolved commissioning areas.
Recommendation 6: A combined authority or a unitary authority should cover a commissioning area and take on all devolved commissioning functions for healthcare, employment services, skills and apprenticeships, and offender management.
Recommendation 7: Local commissioning boards should be headed by a single leader accountable for these decisions. Mayors should not be mandated by central government, however, and local areas should be able to shape their own leadership structure if one elected official holds a time-limited position accountable for public services across the local commissioning region.
Recommendation 8: Local commissioning bodies should form around the outcomes set by the cabinet and leader. Agile procurement teams should tender contracts, and disband after.
Recommendation 9: The Government should expand the role of the Cities and Local Growth Unit to include oversight of the devolution of public-services commissioning. The new unit should be called the Devolution Unit with wider membership from all departments from which powers are devolved.
Recommendation 10: Local commissioning bodies should receive block-grant funding. Local commissioning bodies should only be required to meet high-level outcomes agreed with the centre to receive the funds, and the grants should cover five-year periods. Block grants should be inflation linked and the inflation index and funding formula set by a UK Funding Commission.
Full report: Vive la devolution: devolved public-services commissioning | Reform