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'Health must join debates about how areas raise money, not just spend it'

Michael Wood
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Those hoping that Greater Manchester putting health and care at the heart of its devolution deal would spur innovation around health in local economic planning elsewhere probably feel rather underwhelmed.

They shouldn’t. The report published by NHS Clinical Commissioners today, Shaping Healthy Cities and Economies: The Role of Clinical Commissioning, is an important reminder that the NHS a key player in local economies and that it has, at least in parts of the country, the ideas, appetite and capability to help drive transformational change for its communities.

What the NHS perhaps doesn’t yet have is a routine seat at the table in local strategic economic decision-making. This has to be earned, of course, but as the report makes clear, the benefits are mutual and multiple.

A service for all economies

At a time when the prime minister is focused on bringing prosperity to everyone, it’s worth remembering that one of the particular economic characteristics of the NHS is that it is important everywhere.

In every local enterprise partnership footprint in England the NHS is the largest employer. Furthermore it will have a significant estate, it will be a huge procurer, there will be businesses desperately trying to work with it, it will be reaching out to the most isolated pockets of society and it will be tackling absenteeism, low productivity and well-being. It clearly matters.

The challenge for the health service is to understand its value to its specific local economy and hence where mutual relationships will be best served. Looking across the breadth of examples highlighted in the report from England’s core cities reminds us of the need to be inclusive; what the NHS thinks matters most may not be what interests local partners.

The role of CCGs in driving local growth

One of the main queries in relation to working with the NHS is ‘who do I talk to?’ This may differ across England but the role of clinical commissioning groups is a particularly interesting one. Their responsibilities for population health and strategy, as well as their financial decision-making, make them an ideal channel through which to connect the many parts of the health economy to the wider economy. Sheffield’s Move More strategy is a good example of how complex place-based working can be. To bring together so many partners requires the NHS to have both system leadership and a single, local customer focus.

The answers are usually local

This report is, however, as much of a challenge to the NHS as it is a promotion. If your outcomes are not rooted in the communities you serve then how is your work relevant to these communities and your partners?

Too often, we have measures that only make sense to the NHS. This is why Liverpool CCG’s work to ensure its commissioning addresses the social, economic and environmental wellbeing of its local population is so important. We should not be shy about admitting that someone in work is a good outcome of a healthcare intervention. In fact, it’s hard to think of one that is better. Working out where and how the NHS spends its money locally, and thus understanding its ability to influence its place, should be the rule, not the exception.

Health as an investment, not a cost

I still detect a nervousness amongst health service leaders to engage in the local growth landscape. Some of this is cultural given years of ‘command and control’; for others perhaps they do not feel entirely comfortable with the competitive nature of regional economic development. Whatever the reason, nothing in the report is anything other than good, innovative community engagement.

I spoke earlier about health earning its place at the table. What I think the examples in the report show is an NHS joining in discussions about how a local area raises money, rather than spends it. We often reference health being an investment not a cost; without exhibiting the behaviour of an investment partner this rings hollow.

Many more Manchesters?

As the conclusions make clear, the report is looking two ways. It is as much trying to convince the NHS (both nationally and locally) that focusing on its economic contribution is a core part of its role as it is convincing others that the health service belongs in local discussions. Its impact will therefore also be judged by these different audiences. What NHS Clinical Commissioners has done is to remind us that the leaders of Greater Manchester are not alone in wanting health and care to be explicit part of realising, and reaching, their place’s vast potential.

Michael Wood, local growth advisor, NHS Confederation @NHSLocalGrowth

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