Yorkshire’s NHS is failing to meet people’s care needs, not because of a lack of effort from frontline staff, but because decisions about services, priorities and resources are made at national and fragmented regional levels that do not reflect how people live across Yorkshire.
In too many places, patients are waiting far longer than the standards set by NHS England, particularly for cancer diagnosis and treatment, where delays directly affect survival rates. Evidence from Yorkshire Cancer Research shows that people here are significantly more likely to face long waits for elective and cancer care than patients in other parts of the country.
At the same time, Yorkshire faces some of the starkest health inequalities in England A man living in Hull can expect to live many years less than a man living in York. This is not a small variation; it is a profound gap in life expectancy within the region. These differences are rooted in deprivation, long-term illness, and inconsistent access to timely care — problems that are systemic, persistent, and Yorkshire-wide.
We already know that a different approach can work. Since 2015-16, Greater Manchester has moved towards a more coherent model, bringing health and social care together through a shared political, strategic and commissioning framework for one population. It is not structurally simple, and it is not perfect, but it is aligned around one plan and direction of travel.
Yorkshire has the scale, population, and identity to do the same.
Four separate negotiations
Instead of Yorkshire being treated as one health geography of joined-up planning, it is being drawn into four separate mayor-led negotiations with NHS England and the government.
In practice, this means four political and governance settlements, four leaderships in four different domains, four sets of priorities, and four approval processes. After all of that, Yorkshire still must answer the same basic question in four different ways: what standard of care should our people expect?
This is not merely duplication, costing many millions of pounds that would be better spent on frontline services. It risks hard-wiring existing fragmentation into the system by forcing health provision to align with political boundaries rather than patient needs.
Health services are designed around patient flows and population demand. Devolution of boundaries, by contrast, is drawn for political convenience. In Yorkshire, those two maps simply do not align.
Hospitals, ambulance services, cancer pathways, community services and mental health provision already operate across — and often well beyond — administrative lines.
People in North Yorkshire routinely use services outside the county. In South Yorkshire, many pathways naturally centre on Sheffield but also extend beyond it. Hull’s health links reach across the Humber. This has always been how the NHS functions in practice.
The NHS has long managed this complexity by organising care around patient flows and clinical needs. The direction of travel should be toward better alignment with those realities — not the formalisation of political boundaries that risk entrenching existing divides.
This is not about the mayors
This is not a criticism of the mayors themselves. Across party lines, they are trying to improve the health of the communities they represent. The problem is the system they have inherited, one that divides a single region into multiple political footprints and labels it ’empowerment’.
Nor is this an argument that Yorkshire’s NHS is currently a single neat system. It is not. But what is now happening risks making that misalignment permanent.
Competition already exists between trusts for staff, capital investment and specialisms. The danger is that mayoral boundaries formalise that competition at the political level, rather than resolving it at the regional level.
The wrong scale for devolution
This is often presented as a reduction in Whitehall control. Whitehall is still deciding the scale at which devolution happens — and for health and care in Yorkshire, that scale is too small.
Greater Manchester works not because it is simple, but because it operates with a single political and strategic framework for health and care. Trying to replicate that model through multiple separate Yorkshire deals will not strengthen it; it will dilute it.
The long-term answer
The strongest long-term answer is clear: a single system of Yorkshire regional governance, with the authority, accountability and scrutiny to plan and deliver health policy at the scale the region demands. But under current structures, that option is not yet on the table.
So, the question becomes: what is the best step forward now?
A White Rose Health Agreement
The answer is a White Rose Health Agreement — a single, jointly negotiated settlement between the Yorkshire mayors, NHS England, Integrated Care Boards, universities and community organisations.
One negotiation, one settlement, one strategy. and the One Yorkshire standard of care. This would not require structural upheaval. It would require alignment in funding priorities, workforce planning, prevention strategies, and service delivery across the whole region. It would replace competition with collaboration, and misaligned governance with coherent direction.
Most importantly, it would recognise something the public already understands instinctively: patients’ flowsacross Yorkshire do not respect the political lines now being drawn. Our governance should reflect that.
