This guide has been produced by the Local Government Association (LGA) and NHS Clinical Commissioners (NHSCC) to provide key prompts and actions for local leaders to promote strong localised decision making across health and local government.
We have long advocated the benefit of taking decisions as close to the communities they impact as possible, such as through our shared vision for health and care integration – ‘Shifting the centre of gravity’.
The events of 2020 have highlighted the need further, both in requiring health and care partnerships, to respond in unison and at pace to the COVID-19 pandemic, as well as ongoing implementation of the ambitions in the NHS Long Term Plan around primary care networks (PCNs), place-based partnerships and the ongoing establishment of integrated care systems (ICSs).
Subsidiarity and the response to COVID-19
During COVID-19 response, what worked well is local place-based planning and delivery, when it was allowed to flourish.”
Health and care partnership director
The relationships we have built up have paid dividends during COVID. We’ve worked together for our residents.”
Leader of a county council
In our ‘Six principles to achieve integrated care’, the LGA, NHSCC and partners brought focus to subsidiarity. The six shared principles have been well received by health and care leaders, who have found them helpful in testing whether their own partnerships are underpinned by the right principles and values. In developing this guide, we are responding to local authority and clinical commissioning group (CCG) leaders who have asked for practical guidance to put the principle of subsidiarity into action in their areas.
Subsidiarity − Subsidiarity − system leaders are committed to making decisions at the most local level, as close as possible to the communities that they affect. Accountability mechanisms for new health and care partnerships will build on existing structures, including health and wellbeing boards and local authorities, clinical commissioning groups and provider organisations. New governance structures are open, transparent and locally accountable. From ‘Six principles to achieve integrated care’
The principle of subsidiarity is important because it ensures:
- there is clarity about which decisions are best made at a local level in order to respond to the needs of individuals and communities, and which decisions are best made at a more strategic level to achieve economies of scale
- local communities are involved in making decisions about services that affect them
- decisions are made once, are empowering, accountable and transparent.