In many respects, the NHS was already moving in this direction under Keir Starmer. The NHS Modernisation Bill strengthens the role of Integrated Care Boards (ICBs) as strategic commissioners of local services and, despite greater ministerial oversight following the abolition of NHS England, places more responsibility for planning and delivery in the hands of local systems.
There are, however, good reasons to believe Burnham would take this agenda further.
Burnham’s political instincts have long favoured devolved decision-making. As Mayor of Greater Manchester, he pushed for an extension of the city’s health settlement which meant ICB Chairs were required to report directly into him. It would therefore be no surprise to see metro mayors and combined authorities given a stronger voice in determining regional health priorities and investment decisions.
More fundamentally, Burnham has never viewed health policy as something that begins and ends with hospitals, GP surgeries and waiting lists. He has consistently argued that health outcomes are driven by a wider set of social and economic factors, including housing, employment, education and poverty. In Greater Manchester, this philosophy has been embodied in the “Live Well” approach, which recognises that improving health requires coordinated action across public services rather than interventions from the NHS alone.
If this thinking continues to influence government policy, the implications for health public affairs are significant.
The Department of Health and Social Care will remain the primary centre of policymaking and ministers will continue to exercise control. However, regional actors are likely to wield greater influence over priorities, investment decisions and service transformation.
What is not yet agreed upon is how devolution will look across the country. If you need evidence that there is not a one-size-fits-all solution to health devolution, it’s the debate this week in London, where Labour MPs have reacted “furiously” over the Health Bill’s plans to grant the Mayor additional health powers despite healthcare not traditionally falling within City Hall’s remit.
For organisations seeking to shape health policy, understanding Whitehall will remain essential, but no longer sufficient.
A purely NHS-focused case may carry less weight than it once did. Health organisations will increasingly need to demonstrate how their proposals contribute to the government’s wider missions, including reducing inequalities and supporting local economic growth.
They will also succeed by illustrating how proposed policies will support prevention. On the steps of Downing Street, Burnham promised a more “preventative State” that avoids simply “paying for failure”. Illustrating how reforms will avert problems downstream will be well-placed to resonate with decision-makers.
As decisions become increasingly place-based, stakeholders will need to show how their proposals support local system priorities.
That means drawing on robust local evidence and tailoring engagement strategies to regional circumstances. We have already seen the value of this approach through our work with health clients, helping them build cases that resonate both nationally with ministers and regionally through targeted evidence and stakeholder engagement.
Devolution is becoming an increasingly important feature of the health policy landscape, but it remains an evolving and often uncertain area. Even Greater Manchester’s model, now more than a decade old, continues to develop. As The King’s Fund noted in its 2024 review, “Greater Manchester’s journey has not been all plain sailing, and it isn’t over.”
At Luther Pendragon, we help clients navigate complex health policy environments, build compelling evidence bases, engage key decision-makers and develop campaigns that resonate with both Westminster and local stakeholders.
To find out more, contact publicaffairs@luther.co.uk