With the Government unveiling its dramatic plans for shaking up the health sector, Rob Whiteman examines the future role for local government
Local government and health are inextricably linked in the lives of communities. People judge the quality of where they live by the calibre of hospitals or walk-in centres, just as they assess schools or libraries.
The public servants on our streets, whether refuse collectors or the police, of course, have a significant effect on perceptions about the immediate neighbourhood.
But ask someone about place – their town or village – and their views, good or bad, will often be determined by the proximity of good medical services.
Localism is all about this, where, by several different means, decisions are increasingly made by people who are elected or practise locally to improve places.
How people feel about the NHS affects how they vote nationally, but not as often how they vote locally. Local government has, rightly, argued that the local democratic deficit in health should be addressed, and although at first sight, changes to NHS commissioning suggest we’ve lost this one, there is undoubtedly an opportunity for local government in the proposed changes.
The present relationship with the NHS in many areas is patchy. Councils and PCTs are main players on local strategic partnerships, but the degree of trust, joint working and pooled budgeting is varied.
There are good examples of PCTs investing in prevention, such as leisure or youth services, but this is not the norm. Relatively-few councils have close and deep relationships with local GPs and other parts of the health economy.
Of course, where it does work well at present, we have heard good commitments from the Department of Health that this should be sustained. We should also reflect that often, many GPs have long-standing community ties and so, like councillors, have a sense about what’s needed.
If these changes create a more direct relationship between GPs and councils than occurred through the intermediary of PCTs, then this would be a good thing.
If the proposals, as they stand, are approved by Parliament, there are chances for fresh starts locally. Through health and wellbeing boards, elected members with responsibilities for public health and social care budgets and GPs responsible for healthcare budgets can do business about local priorities and services.
The constructive way that the Department of Health has, so far, identified around 20 areas to be early adopters of shadow health and wellbeing boards is welcome.
Some areas will adopt shadow boards in 2011 so that all authorities can have them operating on a non-statutory basis during 2012/13, ready for the new arrangements to be in place for councils to give leadership in integrating commissioning from 2013/14 onwards. The department is also writing to all councils asking for interest in joining a network to promote this work.
Naturally, there is a great deal which is difficult to predict at this stage. For example, after a few years, who most likely will support GPs in their commissioning roles? Will GP consortia be supported by a range of commissioning support providers, such as former PCT staff, or will the market tend to gravitate to a handful of large companies, owing to the scale of investment needed in systems and procedures?
Also, while the above all focuses on strategic planning and commissioning, what integration will occur at the frontline between the providers of community care, which have been moved at arm’s length from PCTs and councils’ social care services?
Of immediate interest is the transfer of the public health role and local budgets to local government. This outcome with a significant element of budgets reserved for Public Health England. Ring-fenced local budgets, and quite cumbersome staffing structures are not ideal, because this runs contrary to embedding and mainstreaming public health in a way that fits with local arrangements.
Ring-fencing may mean, for example, that councils initially charge into these budgets rather than think about topping them up. But all that said, the proposals are a step in the right direction and give councils the ability to develop tailored public health interventions which fully join up with a range of preventive services.
This new settlement also gives elected members a new impetus through both scrutiny and executive arrangements to have impact on health to meet local objectives. This will be a key priority for member development support from Local Government Improvement and Development (LGID), and also allows council and partnership leadership teams to adopt whole systems approaches.
Finally, while discussing the opportunities of the new arrangements, together with some of the issues we think could be improved by government, the relationship between the Department of Health and the local government sector is good, which bodes well for making a success of the new system based on constructive and mature dialogue. Leading LGA politicians are being fully consulted by ministers and local government through Cllr David Rogers, chairman of the LGA community wellbeing board. Other colleagues are working alongside senior officials on the Department of Health transformation board.
Similarly, Sir David Nicholson, recently confirmed as chief executive of the Commissioning Board for England, and his NHS management board have sought local government involvement in their forthcoming assurance reviews of strategic health authorities to that ensure our sector’s perspective is at the centre of the implementation of new arrangements.
So, while it is early days, we can reflect that the manner of engagement so far, and the way plans are being made to meet timescales are positive. And this now creates an opportunity for councils and the health economy to build networking and share ideas, ready for the changes ahead.
Rob Whiteman is managing director of Local Government Improvement and Development
