We work in challenging times. It seems that barely a day goes by without another reminder of funding pressures’ potential impact on care for the most vulnerable and on residents’ wider health. As the only serving adult social care director leading a sustainability and transformation partnership (STP), I know this all too well.
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This was never going to be the perfect backdrop for the NHS to attempt what it calls the biggest national move to integrated care of any major western country. NHS organisations are, of course, attempting heroic savings of their own.
While debate about money is important and should continue, STPs’ ambitions are wider and their collaborative approach remains the right one. The financial backdrop makes it more important that we work closely with NHS colleagues.
The sense of shared enterprise is at an early stage in many areas. Councils and the NHS are two worlds with distinct cultures and languages. The NHS has its own local quirks and complexities – addressing these was rightly many STPs’ priority and will take time.
We know not every council felt welcome in early stages to contribute as much as they could, and councillors felt this acutely. To quote one health and wellbeing board leader: “When I am not consulted early I become capricious”.
However, partnerships have grown considerably during the past year and are beginning to yield results.
Collaboration can better meet changing care needs. A simple phone call to our local health and wellbeing facility in Ashfield triggers home visits from a care team of both social care staff and NHS nurses. They support recovery, stabilising symptoms and helping residents (who may be housebound or at risk of being admitted to hospital) to manage their own conditions.
And information-sharing between the two councils and the NHS in my own STP has improved planning, meaning residents can avoid entering hospital or care home and, if needed, have a quicker and smoother transfer from hospital.
Residents in 2017 need the best of health, social care and wider public and community services. Over the past 70 years the NHS has helped us to live longer. When funded appropriately, social care provides person-centred, co-ordinated care for those who need it. We need to blend these two traditions.
The progress we have made – and there is still a long way to go – has happened because of sustained joint effort between our councils colleagues and NHS counterparts, with shared focus on tangible improvements.
Challenges remain. We need to find governance arrangements that reflect different accountabilities – the NHS nationally to Parliament and government, councils to local politicians and residents – while recognising that solutions are still developing and may not be the same everywhere.
But this is not a time for criticising from the side. It is crucial that we all take a seat at the table and seize the opportunity to lead conversations that should have been happening for years. The main mission of local democracy is the economic and health and wellbeing of our citizens. There is a major leadership role for councillors, given their democratic mandate and strong citizen focus.
Strong, equal partnership is essential. The stakes are too high to fail.
David Pearson, director - adult social care, health & public protection; deputy chief executive, Nottinghamshire CC, and leader, Nottingham and Nottinghamshire STP
David Pearson: NHS and councils must work together – or fail alone