How local government’s relationship with the NHS is changing
Some useful thoughts about how Local Government is shaping up with its new NHS partner in the world of Health and Well-Being:
Although, arguably, local government has contributed more to the health of the nation over the last century than the NHS itself, the relationship between these two public service silos has often been troubled.
The currency of power and responsibilities has been one-way traffic: in 1974, large swathes of health provision that had remained with local government, including public health, moved across to the NHS as part of a huge reorganisation of both services. As medical journal the Lancet put it, running health services was “too important to be left to the local citizenry”.
However, in 2013 the tide has turned. The government’s NHS reforms see public health returned to its home in local government and local authorities are given a new leadership role through the creation of health and wellbeing boards, charged with promoting integrated services and setting local strategies for health and wellbeing. So will 2013 be a watershed moment in the relationship between the NHS and local government ?
But these are early days and three key questions remain.
The first is how far councils will support NHS partners in driving through essential changes in how local services are delivered.
The second is about money and whether austerity will either provide the burning platform for change or stress test local relationships to destruction. This will play out differently; places with tradition of good local relationships have a better chance of weathering the financial storm. It raises questions about whether the architecture of local public services is sustainable. Do the one million people of the shire county I was working in recently really need 25 different public bodies to deliver their health and social care services?
The pattern of clinical commissioning groups and district councils does not look sustainable but the politics of local government boundaries are tricky and there’s no appetite for more reorganisation.
The third issue is whether local authorities and the NHS can achieve a breakthrough in offering the kind of well-coordinated, integrated care that almost everyone agrees is vital.