The NHS and local authorities have a long and highly variable track record in partnerships for health and well-being and in integrated care services. Personal leadership styles and willingness to seize rare and brief windows of opportunity have been greater forces for innovation than national policy imperatives for prevention and service integration.
How can we ensure a more sustainable spread of best practice as some primary care trust responsibilities transfer to local government? NHS mind-sets have often been formed in the pressure cooker of rising emergency admissions and obstacles to effective discharges. Local authorities frequently speak of frustration at the fragmentation and tribalism between hospital and community health and social care services, reflected in the representations to councillors from constituents. Both will fear shifts in the burden of costs, in the tightest economic conditions current leaders have known.
Into this cauldron is poured the liberating intentions of “Equity and Excellence” and local government’s place-based devolution agenda. Out leaks a wealth of experience and expertise from both sectors as their mandated contributions to balancing the public sector purse hit home. Rarely has it been so crucial for the local NHS and local authorities to fully comprehend their respective accountabilities, structures and cultures. So how well do you really know what makes your partner tick?
Beneath the surface of local strategic partnerships, the reality is that the NHS and local government are two very different tribes with separate heritages, systems of belief and sources of governance. Of particular importance is the contrast between the single-purpose authority focus of statutory NHS governance and the multi-purpose authority governance captured in local government constitutions.
The nationally directed NHS and social services, together with education, are in many respects organisationally more similar to each other than to other local authority departments. More electorally significant development planning, neighbourhood, economic and environmental agendas dominate many cabinet and council meeting agendas. PCTs, local authorities, the NHS Confederation and the Local Government Association have a critical role in fostering councillor and senior management understanding of the NHS and how to effectively integrate this within the wider local government place-based agenda.
Devolution of the economic development agenda and re-organising to fully capitalise on the place-based devolution and neighbourhood agendas dominate local authority leaders and chief executives diaries. Many have not yet fully absorbed the electoral consequences of those NHS service reconfigurations and individual continuing care cases which would no longer be insulated from cabinet and council decision-making. The leading-edge public service governance partnerships in Herefordshire CC and Hammersmith and Fulham LBC offer transferable learning from experiencing the twin demands of the NHS Quality, Innovation, Productivity and Prevention (QIPP) and local government customer and shared service transformation programmes.
There is great potential for falsely assuming each partner understands the other’s agenda and shares a common view of how best to improve health and configure local health services. As PCTs and health authorities depart stage left - traditionally the local shock absorbers of the NHS - the terrain for misunderstandings between GP consortia and local authorities becomes considerably more rugged. Superficial stereotypes abound - not least about councillors and GPs - and need to be openly and honestly confronted through shared learning and neighbourhood co-leadership opportunities.
New relationships between local authorities, GP consortia, foundation trusts and other social and private sector enterprises are likely to re-shape the roles of directors of public health, adult services and children’s services, cabinet portfolio holders and others as system leaders. These changes are essential to releasing the wider potential for social innovation and economic sustainability in preventative and early intervention services. It remains very exceptional for either NHS or local authority chief executives and directors to have been employed in both organisations, with the depth of corporate experience, regulatory compliance and political insight that brings.
Experience from the establishment of PCTs and children’s services directorates highlights the importance of early attention to professional and organisational development opportunities for senior leaders with newly extended portfolios, combining both NHS and local government leadership talents.
Andrew Williams, director, Options 2 Outcomes consultancy and former NHS PCT chief executive, local authority director of children’s services and adults social services and joint NHS and local authority interim director.