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Devolved powers will bring unfamiliar challenges

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Devolution will be the top topic of conversation at the Local Government Association conference in Harrogate this week.

It is seen as the key to complex service reform across the public sector, leading to joined-up services that release substantial savings as a result.

More than half of respondents to LGC’s pre-election confidence survey expressed an interest in taking on devolved powers for health.

But as outgoing Local Government Association chief executive Carolyn Downs warns in her interview with LGC, councils should be wary of the risks they are taking on in the rush to merge services.

As she makes clear, local government could easily find itself exposed, not enjoying the central government protection afforded the NHS as a national service or the shelter provided by powerful clinical and patient lobby groups.

Some in local government perceive the NHS to be an inefficient service that they could help improve.

Buoyed by an impressive record in finding big savings during the past parliament, councils could find significant savings within the health service if only they were given the chance.

This justifiable sense of achievement should, however, not be allowed to turn into a misplaced bravado.

They should not assume that savings of a similar scale can be wrung from the NHS without too much pain.

NHS colleagues do have a tendency to look up for solutions, rather than within their own organisations.

A further example of the extent of central control over the health service was given this week, when it emerged the health secretary would overrule decisions made by integration pioneer Greater Manchester that he considers are “wrong”.

The example given was if a combined authority suggested closing large numbers of beds to deliver care closer to home.

It is easy to imagine the political pressure Ms Downs talks about being brought to bear on the health secretary were that to be the case.

As well as powerful health lobby group, the NHS must also contend with a huge number of rules and regulations.

These dictate not just what services must be provided but how they must be delivered down to an astonishing level of detail

This leaves much less room for manoeuvre, particularly in the most expensive and complex services which are subject to reams of guidance from NICE and the medical royal colleges.

Many a visionary clinician or committed manager has been defeated in their attempts to implement change by these and many other factors.

All of that is not to say there is not much that health colleagues could learn from local government.

Councils have shown innovation, invention and self-reliance when dealing with huge cuts over the past five years.

The local politicians that many in the NHS are so wary of have been at the helm of taking those difficult decisions.

But councils should make sure they are entering into any integration plans or devolution bids with their eyes wide open.

For they can be sure there will be no white knights riding to their rescue if things do not go to plan.

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