If NHS leaders are frustrated by a lack of capital investment holding us back and 10 years of relatively flat funding then spare a thought for our partners in local government, writes Nick Ville, director of membership and policy at the NHS Confederation.
They have been forced to work with budgets that in many cases halved since 2009. These cuts have forced the fundamental transformation of what local government is and the NHS can learn a lot from council partners who have a track record of innovating, driving efficiencies and service re-design.
A town hall in Bristol, Bromsgrove, Barnsley or Sunderland is now a multi-service, customer-facing environment.
Across the country the scope, design and delivery of social care services is often unrecognisable from a decade ago.
Local government digital transformation is imperfect, but we report fly tipping and anti-social behaviour through a mobile app and track our children’s school performance on a real time dashboard.
And in places like Wigan, councils are redefining the social contract that they have with communities so that residents aspire to being active partners in healthy, happy, empowered neighbourhoods and not just passive recipients of public services.
This transformation in local government services at pace and with radically reduced funding, feels unprecedented in modern Britain. Councils have engaged and consulted, designed and re-designed, and ultimately cut services in a wide range of areas to meet their statutory obligations, and to do the best they can for their communities within sharply reduced budgets.
In this environment, there are some tensions between local government and NHS partners working together in the new Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICS). Most obviously the funding issue with local government cuts sharply contrasting with the £20bn that has been allocated to the NHS.
Local councillors have made brave, and sometimes unpalatable, choices to redesign the best services that they can deliver within the budgets that they have. They’ve succeeded by being upfront, politically aware, and engaging early with communities and a wide range of stakeholders, and if the NHS wants to transform at pace, then we need to learn from local government.
One NHS system talked about what they face when they come to reconfigure two nearby hospitals, separating planned operations from acute and emergency treatment across two sites as outlined in the NHS Long Term Plan.
“We have to do this. This change delivers better clinical outcomes, it is better financially, it is more sustainable because we can actually staff it, and it represents best practice. But when we do it, we’ll spend £1.5m engaging with communities and we’ll wreck our relationship with local politicians, who will object publicly even if they understand why we need to do it. We’ll lose some of the trust local people have in the NHS brand and our ability to take communities with us.”
As we look for solutions, we need to be learning from the Local Government Association and listening to the Centre for Public Scrutiny (CfPS) whose annual conference this year will focus on what better public scrutiny of public services might look like in the future.
Many partnerships are building better earlier and more informal relationships with local health scrutiny, bringing them into the tent so that they are involved from the outset in transformation discussions.
We can make arguments around the opportunity cost of not transforming NHS services. Forced to maintain inefficient models of care, NHS partners can’t invest in the things that we know really make people happy, healthy and economically productive.
But really the solution to this cognitive dissonance lies in building long-term genuine and trusted relationships with our local government partners.
In Salford, pooled NHS and council budgets have allowed the NHS to transfer monies into public health, when central government public health allocations were reduced. That comes from trust, and a shared understanding of the most effective way to improve the long-term health of a local community.
And in Greater Manchester, the reconfiguration of hospital services across 2.6 million people will be facilitated by a shared vision between council and NHS partners, calmly and sensibly through the trust that has developed across the whole of the partnership.
Author Steven Covey’s adage “change moves at the speed of trust” is perhaps the most quoted phrase we hear in STP/ICS working across England. It is hard, especially in the early days to build this trust and it is sometimes unclear why we are putting the work in.
But the dividend in the ways it will allow us to re-imagine and transform NHS services will be substantial, and well worth the investment.
Nick Ville is director of membership and policy at the NHS Confederation.