Councils grappling with the long-standing problem of how to integrate health and social care should seize the opportunities provided by devolution and Brexit, according to leaders from the sector.
The economic uncertainty facing local government since the EU referendum makes it more challenging but also more important to make some headway on integration – a major issue with both organisational structures and culture highlighted by communities secretary Greg Clark in his address to the Local Government Association annual conference this week.
“There’s a huge opportunity for local leadership to take control of this issue and to use the fact that there’s a policy vacuum in Whitehall to create pace behind joining up health and social care,” said Stephen Dorrell, former health secretary and chair of the NHS Confederation.
Speaking from the audience at a Guardian debate at the LGA conference in Bournemouth, he picked up on a recurring theme: that managers should not be aiming solely for integration of health and social care, because health outcomes need to be embedded in all local policy areas, including housing, economic growth and jobs.
“There’s an opportunity for the development of a genuine civic agenda because there’s nobody in Whitehall to pick up the telephone to stop you,” he said.
Political upheaval has followed Britain’s decision to leave the EU, with the Labour party in disarray and a Tory contest underway to choose the next prime minister. The care minister Alistair Burt has just announced he will resign in September.
Tony Hunter, chief executive of the Social Care Institute for Excellence, speaking on the panel, said: “The more we locate integration within the wider devolution agenda the better”. He called for “superb systems leadership”, with more humility and dissemination of best practice. The best systems leaders, he said, are able to frame changes that could be unpopular, such as hospital closures, in a way that can be “owned by the local politician”.
“We all know that the real challenge is how we invest in prevention,” he said. “We can’t do that if we’re held to account simply for the leadership and management of our own organisations.”
The discussion, held in partnership with KPMG, focused on sustainability and transformation plans (STPs) – which have been produced by every health and care system in England to demonstrate how local services will become sustainable over the next five years. They are the latest in a raft of initiatives designed to try to fix the health and social care system in England.
STPs, according to Richard Samuel, debate panellist and leader of the Hampshire and Isle of Wight STP, are “like every policy, both inspirational and flawed”. Samuel, who is also the chief officer for NHS Fareham and Gosport CCG and NHS South Eastern Hampshire CCG, said this initiative should be given a chance. But he warned of the danger of viewing STPs as an entity in themselves, rather than a vehicle to bring together a range of existing local programmes that already make sense for people.
“It’s absolutely not another plan that sits on top of everybody else’s plan and directs it in an adversarial sense,” he said.
Only four of the 44 STPs are led by local government: these four, it was widely agreed by members of the panel and audience, are making significant progress. In other areas, the plans have exacerbated existing tensions between health and social care practitioners, and some cover several local authority areas, forcing partnerships between councils that are not used to working together.
Tim Gardner, interim director of policy at the Health Foundation, said: “The STP approach is absolutely the right one, but we’ve got to recognise that some areas have a much longer history of working together … for other areas, it’s much newer to them.” He called for national policymakers, from the health and communities departments, to support local plans and adopt a more enabling role rather than trying to take back control of the health agenda.
He said he hoped a new prime minister would allow local leaders to stay the course. “There’s no right solution; the only wrong solution is to keep changing our minds,” he said.
For Joanna Killian, head of local government at KPMG, it all comes down to the strength and bravery of leaders. Asked about what progress she thought councils could make over the next 12 months, she said: “I think we won’t be talking about integration; we will be talking, I hope, about leadership in local places. It’s the moment for local leaders to really offer something different.”
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