We agree with the PM that civil society belongs at the heart of devolution - let's make this commitment count!

We are fortunate that Newcastle upon Tyne has been taking steps towards reducing health inequity by becoming a Marmot city, meaning our local authority is an official partner of the Institute of Health Equity, and is working towards addressing the social factors that impact the health of our citizens.  

For many years, all of us at Ways to Wellness have been building the evidence that demonstrates that to enhance our nation’s health we must go far beyond improving our healthcare system. We've consistently argued that if the UK is serious about tackling health inequalities, supporting economic participation, and building a sustainable NHS, then alongside advances in clinical care, we must address the impact poor quality housing, unstable employment, financial insecurity, low confidence, and limited social connections can have on individuals and communities.

Of course this means investing in prevention, as well as designing systems around people and place, rather than organisational boundaries. And it was good to see this recognised in the government’s 10-year plan for the NHS, launched last year, but it appears our new Prime Minister Andy Burnham is prepared to go a step further, with the commitment announced this week by Downing Street’s Partnership Unit that civil society is being placed at the heart of the devolution agenda. 

A welcome commitment

This is an important moment, because it reflects a fundamental truth we at Ways to Wellness have been demonstrating for more than 11 years, that while the organisations closest to communities are highly effective delivery partners, they are also vital strategic assets whose insight, relationships, and evidence should shape how devolved systems are designed.

If devolution is to succeed, especially for regions such as the North East, whose levels of healthy life expectancy are lowest, civil society should not be consulted after priorities have been set. It should help determine those priorities from the very start.

Hopefully this pledge signals the point at which consensus can transform into meaningful action. Across health and care, it’s now understood that the requirements of the future can’t be delivered through traditional institutional models alone. The shifts from hospital to community, from treatment to prevention, and from fragmented services to neighbourhood-based support depend on genuine partnership between public services and the communities they exist to serve.

Turning promise into practice

For too long, the voluntary, community and social enterprise (VCSE) sector has been commissioned once priorities have already been agreed, invited into conversations once decisions have been made, and crucially, we’ve been expected to solve complex social challenges without being involved in shaping the systems that created them.

If devolution is to play a large part in creating healthier places and stronger communities, that model must be left in the past. Rather than being a stakeholder round the table, the VCSE must be empowered to help design and build the table itself.

The organisations embedded within our region’s communities bring something fundamental to system reform. They hold trusted relationships with people whose voices are often absent from traditional planning processes, they understand local assets as well as local need, and are often the first to identify emerging challenges, the first to innovate, and the first to build partnerships across organisational boundaries.

These are not supplementary functions, but essential capabilities for a health and care system seeking to prevent ill health, rather than just respond to it.

Recognition is not enough

At Ways to Wellness, whether we’ve been supporting people living with long-term conditions, developing new approaches to social prescribing, or helping systems test innovative models of care, we’ve seen time and time again that trusted, person-centred relationships unlock outcomes that traditional services alone simply can’t achieve.

Importantly, we’ve measured and documented those outcomes. The challenge now is ensuring this evidence informs decision-making at every level of the system. Relationship-based approaches are not ‘soft’ interventions that should sit alongside clinical care. They must be accepted and taken forward as evidence-based components of a modern health system - improving wellbeing, reducing the impacts of inequity, and alleviating pressure on overstretched services.

Devolution provides us with a real chance to embed that thinking into neighbourhood-level governance, so the VCSE is no longer placed on the periphery of public service reform.

Local leaders are better positioned to understand the complex interaction between health, housing, transport, employment, education, and community infrastructure than any single national organisation ever could. Decisions taken closer to communities have the potential to be more responsive, more integrated, and ultimately therefore - more effective.

But on its own, devolving power won’t deliver those outcomes. The way in which partnerships are constructed matters just as much as where decisions are taken.

From ambition to action

A civil society at the heart of devolution means that alongside NHS organisations, local authorities, universities, and businesses, VCSE organisations, and the communities they represent, must be embedded from the word go - helping shape priorities, influencing commissioning, designing evaluation frameworks, and contributing to strategic decision-making.

Put simply – better decisions depend upon inclusion, and that is the promise of devolution.

If we overlook the expertise held by those communities experiencing the poorest health outcomes, who frequently possess extraordinary community assets and grassroots knowledge from relationships built over many years, through trust, consistency, and shared purpose, then we risk reproducing the very inequalities we’re trying to reduce.

But if we embrace it, there’s an opportunity to create a genuinely different model of UK health and care, based on devolved governance that values lived experience alongside professional expertise, that rewards collaboration rather than competition in its commissioning, and that invests in community infrastructure as seriously as it does clinical infrastructure.