Recommendation 23

Local areas would value more flexibility about where they can direct their resources to achieve greatest impact, including how they fund measures to prevent ill health. ICBs were supposed to have greater autonomy in determining how to allocate resources locally compared to their predecessor bodies, including freedom to shape future local health services. However, there is widespread agreement that NHSE’s approach to planning and governance, in particular the all-encompassing nature of its top-down guidance, has meant negligible autonomy in the real world for local health systems.40 NHSE told us there are certain prevention programmes, such as for diabetes prevention or targeted lung health checks, where it made sense to fund activities nationally rather than giving local areas discretion over whether to deliver those services.41 Moving care from hospital to community