title: Health benefits from devolution in England: international lessons.
abstract: The Chancellor of the Exchequer's recent announcements to devolve decision making power from Whitehall to 30 English regions provide a challenge to use devolution to deliver more favourable health outcomes. However evaluation of devolved health models internationally is scarce, because it is rarely considered. Evidence from countries with long-standing experience of devolution finds that the best approaches are holistic, seeking fiscal freedoms to sustain the environment, promote health, well-being and citizen engagement. Overall, international outcomes are mixed, with some evidence of greater efficiency of care delivery but little hard evidence of better clinical outcomes or health status. Handling specialised services in a devolved health system is challenging. Regulation by national authorities is important to avoid gaming of the system by providers. Information from the devolved area is important in demonstrating equitable access. We present an evaluation framework and recommend that evaluation continues through governance of these deals during implementation.
authors.affiliation: London Division, Public Health England, London, UK European Centre on Health of Societies in Transition, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Doyle
authors.affiliation: Public Health England, Leeds Metropolitan University, Leeds, West Yorkshire, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Johnstone
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration / Q000639:trends; D004739:England; D006291:Health Policy; D006801:Humans; D017146:Models, Organizational; D009936:Organizational Innovation; D011634:Public Health / Q000379:methods / Q000639:trends
keywords: Health and care devolution; PUBLIC HEALTH