A throwaway remark by a senior NHS leader about the need to manage local politicians drew a sharp retort from the floor at the recent national children and adults services gathering in Manchester.
He was talking about the preparation of sustainability and transformation plans, one of the hottest topics on the programme.
He spoke as the 44 plans were being finalised and as a number of local government leaders had spoken out about them, or broken ranks and published them against NHS England’s wishes.
His comment highlighted the challenge for the STP exercise of thinking about the transformation of healthcare over a five-year period in a context of diminishing resources and growing demand. It is no longer an internal exercise about hospitals, care pathways or conditions. It requires a broader canvas, covering primary, community and social care services and the consequent shift of focus and resources. Expectations are high.
Earlier at the conference the care services minister David Mowat had said plans that did not involve local government or address social care pressures would not be approved. Mind you, he had earlier told GPs that failure to involve them would be unacceptable too.
The King’s Fund has also weighed in with evidence of a lack of engagement of patients and the public in the plans’ development.
These issues of engagement were obvious and inevitable from the outset. It was sensible to take a place-based approach to planning health and social care services and to recognise the wider interdependencies with other local services and population characteristics. To do this on footprints of over a million people and across a range of administrative boundaries and hospital catchment areas was bound to cause an upset.
It might make sense from the top of a planning hill or based on general principles but the roll-out and the fall-out would be more local. Patients and their local representatives are suspicious of big plans and their consequences unless they are fully engaged.
The comment particularly upset councilors who are members of health and wellbeing boards and those with public health in their cabinet portfolio. They have spent the last four years getting up to speed with the complexities of the NHS. They have worked with clinical commissioning group colleagues locally to develop a set of priorities, overseeing better care fund and integration plans and worrying about the toxic combination of growing demand on emergency NHS care and diminishing social care resources.
It contrasted too with the ambition and leadership of local councils in coming together across Greater Manchester.
So there must be a next stage for STPs where neither patients nor politicians feel managed out and where fresh thinking and tough choices are carefully explained.
Andrew Cozens, independent social care and health specialist