Plans for comprehensive health devolution across England should be developed within the next year in the face of worsening inequalities amid the coronavirus pandemic, a report has recommended. Democratically led local partnerships could help to create “healthy, resilient and prosperous communities”, the Health Devolution Commission said. The group, made up of five former health ministers across the Conservative, Labour and Liberal Democrat parties, said there was a “compelling ‘burning deck’ of circumstances that requires an urgent and radical response”. It said the pandemic had had a disproportionate impact on economically disadvantaged and black, Asian and minority ethnic communities, that people with health conditions such as cancer and dementia had been badly affected, and that NHS and social care services were “deeply divided” while the demand for care was increasing. Andy Burham, the mayor of Greater Manchester and co-chairman of the commission, said the pandemic had shown the “limitations of an overly centralised approach to health delivery”. He said: “As we look to build back from it, and particularly in those communities hardest hit, we need to do something different. “Health is built in homes, families and communities more than hospitals. But health policy in this country is still too focused on treatment rather than prevention.” He said his role as mayor allowed him to have a vision for health in Greater Manchester “because we can break out of the Whitehall silos and link health to housing, education and employment”. He added: “This simple difference makes the argument for health devolution. And it is now the solution of our times as we begin to face up to the inequalities exposed by Covid-19.” Among the commission’s recommendations is that local social care and public health services such as physical, mental and acute care in the NHS should be integrated. It also calls for a “health in all policies” approach to other services such as housing, employment, transport, education, the environment and economic development. It says plans should be developed across England within 12 months “through a new comprehensive health devolution mandate agreed jointly with locally elected leaders that reflects local boundaries and organisational footprints”. The report said close working relationships would be needed between clinical and civic leaders, as well as community involvement and parity of esteem between the public, private and voluntary sectors. The report said that while health devolution was already under way in different ways in areas such as Greater Manchester, London, West Yorkshire, Harrogate and combined authority areas, there was no “common, consistent or comprehensive understanding” of what it should look like, its benefits or how it should be developed. Alistair Burt, a former Conservative minister for community and social care, said: “After long deliberation and years of experience, we are clear about the case for change, submit this report as a formal contribution to that debate, and call on the government to meet its aims of building back healthy, resilient and prosperous communities through radical comprehensive health devolution. “I very much hope that it will consider in depth its four recommendations including giving legislative support to comprehensive health devolution and establishing new mechanisms of accountability and scrutiny.”