Councils should exercise “extreme” caution before agreeing to ambitious health and social care integration deals, the outgoing chief executive of the Local Government Association has warned.
In a frank and wide-ranging interview, Carolyn Downs told LGC that authorities should carefully weigh up the risks of merging services and budgets with sectors such as health, which are better protected by politicians.
Ms Downs, who announced last month she was resigning from the LGA to become Brent LBC’s chief executive, said the “whole issue of shared risk is something which could get in the way of integration”.
“Local government will need to be extremely careful that it can afford to take on any additional risk,” she added.
Health and social integration harboured greater risks for authorities than the NHS because of the health service’s higher political priority, she indicated.
“There is a clear recognition that local government is effective, efficient and gets things done. The NHS shouts loudly and gets what it wants. That’s because it is a top political issue in a general election and because it is a national service.”
Unlike the NHS, local government was not a “protected budget”, Ms Downs added.
She predicted the next three years would be “extraordinarily difficult” for local government and referred to her return to a frontline local government job as like “going into a fire storm”.
She named the biggest regret of her four-year tenure as the failure to secure a “transformation fund” and longer-term funding for the Better Care health and social care integration project.
Under the LGA’s proposal, the transformation cash would have been used to help keep hospitals open while new services, funded by the better care fund, were set up.
“If you have two systems which are creaking financially, you can’t just say: ‘pool your budgets and integrate – it is going to get better,” she said.
“People will rail against the closures of beds or hospitals until they can see something in place that is better.”
As well as the risks posed by integration, Ms Downs pointed to welfare reform and social services as major challenges facing local government.
“One of the biggest issues for councils is recruitment of social workers; they have become the whipping boys of the media. Add to that the downward pressure on pay and it makes their job even more difficult.”
Ms Downs is due to leave the LGA at the end of this month and will join Brent as its chief executive in September.
LGA top job open to applicants from outside the sector
The top job at the Local Government Association should be open to candidates without direct experience of running an authority – but only those with “credibility” within the sector, the outgoing chief executive has indicated.
Carolyn Downs told LGC it was “not absolutely necessary” to have a former council chief executive at the head of the representative body but that “you can’t do this job unless you have credibility in the sector”.
She added: “You may have that from working closely in the sector or with Whitehall or from a lobbying or policy job.
“Whatever, you need to feel absolutely passionate about how local government can transform people’s lives and that isn’t a mechanistic thing.
Ms Downs said she had always planned to serve just four years in the post. “This job needs a huge amount of energy and a massive commitment to local government. I personally think four years is enough.”