What is going on with the governance and oversight of the NHS locally? And why are local government leaders getting agitated about it?
Five years after the Care Act, councils are entering another round of local elections in May no clearer on the medium-term future of adult social care.
Meanwhile the NHS can publish a long-term plan to shift the balance of care inside the health service and contemplate substantial investment in digital technology. The drivers for this change are sustainability and transformation partnerships (STPs) and integrated care systems (ICS).
Unlike their first iteration, these plans approaches are more internally NHS-focused and often carry aggressive savings expectations. It seems the NHS is in a hurry to address structural weaknesses, quality variation and service rationalisation, as mandated by the new settlement. There is a stronger national process for setting and measuring expectations.
Many of the first round STPs followed boundaries that did not match existing partnerships. This was offset by a promised focus on population health, prevention, and closer working across health and social care, up to and including integration at scale.
Those that worked best understood the importance of connecting with communities, recognised the significant differences in places within the area, and built on existing partnerships. Belatedly, they sought to align themselves with health and wellbeing board priorities and think about how outcomes could be scrutinised.
Unlike Greater Manchester, where health devolution was based on decades of collaboration, these were still largely fledgling alliances when the NHS plan dropped into their inboxes.
Local government leaders generally gave STPs the benefit of the doubt first time round, though many reported that agendas and programmes were complex, technical and focused on providers. Councillors were less positive, often being briefed rather than engaged, and feeling like window dressing.
Directors of adult services struggled to make the connection with local better care fund plans, or to progress the integration of social care and community health services.
Mark two STPs roll out integrated care systems across the country by 2021. They are predicated on a single clinical commissioning group for each system. Each ICS will have one partnership board representing commissioners, trusts, primary care networks, councils and the voluntary and community sector.
They in turn will contract with integrated care providers, allowing contractual integration of primary care services with other parts of the NHS for the first time.
This feels like NHS business. Local government will watch with interest whether these are national franchises or offer real opportunities to identify, agree and work together on local priorities.
Without this flexibility, local leaders will undoubtedly turn their attention to the other pressing concerns of their communities. And another opportunity to address underlying issues together will be lost.
Andrew Cozens, independent social care and health specialist