The chancellor’s Autumn Statement last week underlined the dismal fiscal prospects for public services and nowhere are these challenges better illustrated than in the shared issues facing local government and the NHS.
The inherent dissonance between the ‘national’ in the NHS and the ‘local’ in local government was always going to be a tricky fault line. A further 2% cuts in local authority spending in 2014 on top of the existing 28% reductions over four years will raise bigger questions about the sustainability of the local public service architecture.
Next year’s promised spending review will be the bloodiest yet. And despite recent speculation - the grass around the Dilnot report grows longer.
Yet the biggest challenge - and opportunity - facing local authorities may come from local NHS neighbours, facing the need to find £20bn of efficiency savings by 2015 and at least as much again in the next four years.
It’s not just the money. Our current system of health and care is broken, failing to keep pace with demographic pressures, changing patterns of disease and disability, and higher patient and public expectations.
More people with long-term health and care needs will require long-term support smoothly co-ordinated across professional and service boundaries, not unplanned admissions to hospital.
As well as individually focused services, many local government functions can help improve the health of their local populations and prevent or delay the need for intensive services.
All this will demand a radically different model, a total rethink of how and where services are delivered and funded and the ways professionals, patients and the public engage with each other.
There is a big leadership role for councils here.
Our new programme of work - Time to Think Differently - aims to stimulate debate about the changes needed for the NHS and social care to meet the challenges of the future and how new models of health and care can be achieved.
Richard Humphries, senior fellow, The King’s Fund
For more details on Time to Think Differently, go to: www.kingsfund.org.uk/think