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Local councils work in challenging times. It seems that barely a day goes by without another reminder of the funding pressures we face, with potential impact on care services for the most vulnerable and on our residents’ wider health. As the only serving director of adult social care leading a local sustainability and transformation partnership (STP), I know this all too well.
This was never going to be the perfect backdrop for the NHS to attempt, in its own words, “the biggest national move to integrated care of any major western country”. And NHS organisations are, of course, trying to make heroic savings of their own in the face of ever-rising demand.
But, while the debate about money is an important and complementary one and should continue, the ambitions of STPs always went much wider. The partnership approach that they represent is our best way forward, and a tough financial backdrop makes it more, not less, important that we in local councils join forces with colleagues in the NHS to collaborate even more closely.
The sense of shared enterprise is in its early stages in many areas. Local government and the NHS are two different worlds with distinct cultures and (it sometimes seems) languages. The NHS has historic local quirks and complexities of its own – addressing these was rightly the priority of many STPs and they will take time to solve.
We know that not every council has felt welcome in the early stages to contribute as much as they could and should. Local councillors have felt this particularly acutely. To quote a health and wellbeing board leader I know: “When I am not consulted early I become capricious”.
However, we have seen new partnerships grow and strengthen considerably during the past year, and they are now beginning to yield results for the communities we serve.
For example, my own area, which covers Nottingham and Nottinghamshire, has developed ambitious plans to share information between the NHS and the local authorities.
With the improved planning this allows, our residents can be prevented from entering hospital or a care home and, if needed, can have a quicker and smoother transfer from hospital. Our communities tell us they want more consistent care from home for as long as possible. The evidence tells us that this can be achieved where we join up health, social care and housing with wider services.
New models are providing ways to meet changing care needs. Our local health and wellbeing facility in Ashfield runs a call centre for residents, who may be housebound or at risk of being admitted to hospital.
A simple phone call triggers home visits from a care team including both social care staff and NHS community nurses. The team supports tailored recovery, stabilising symptoms and helping people to manage their own conditions.
‘Integrated care’ has rightly moved in recent years from the dusty seminar room to the front line of how we and the NHS work together. But integration and collaboration are not in themselves the prize. Instead they are the only way for us to transform systems designed, and cultures acquired, in a very different era.
I believe that the residents of 2017 need the best of health, social care and wider public and community services. Over the last 70 years the health service has helped us to live longer, whilst when funded appropriately social care provides person centred co-ordinated care for those who need it. We need the blend of these two traditions.
The progress we have made – and there is still a long way to go – has all happened because of a sustained joint effort between colleagues in our councils alongside NHS counterparts, and a shared focus on tangible improvements.
Challenges remain, not least in the form of divergent policy drivers. The NHS is nationally accountable through its mandate from Parliament and government, but we in councils are accountable to local politicians and residents.
We need to find governance arrangements that reflect that symbiotic relationship, recognising that these are a work in progress and that solutions 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, if not decades. The main mission of local democracy is the economic and health and wellbeing of our citizens. There is a major leadership role for local councillors, given the democratic mandate and the strong citizen focus.
Strong, equal partnership is essential.
This an extended version of a comment feature originally published in a local government magazine.