Health powers should be handed to elected mayors as part of a ‘rejuvenated and fortified wave of devolution,’ a think-tank report has suggested.

The report by Respublica said the move would provide ‘regional democratic legitimacy’ to devolved health and care systems.

Respublica previously proposed a 'path to reform' involving 'transformative devolution to the counties' and 'complete reorganisation in the form of single-tier unitary councils'.

It also suggested that adult and children’s social care departments of local authorities should be merged as part of a plan to integrate health and social care into one unitary system as a ‘first step towards full devolution’.

The report said ‘full place-based devolution of power and authority for health delivery from Whitehall and Westminster to local health and care economies’ was key.

The report read: ‘Devolution to the locality is an inspirational ambition that will mobilise the health and care workforce, reversing its increasingly dispirited outlook.

'It will replace the current jumble of confused jurisdictions and unclear responsibilities, both within the NHS and between the NHS and local authorities.’ On Devo Manc, the report said it had ‘not lived up to initial aspirations,’ adding:

‘Devolution that looked good on paper has not been followed through with the type of delegated executive authority, driven by competent management, over the still-disordered patchwork of local authorities, commissioners, primary care, community-based care and hospital providers.

'In conclusion, a rejuvenated and fortified wave of devolution needs to be launched.’