How local government's relationship with the NHS is changing

In April 2013 local authorities took over responsibility for public health, which includes healthy eating. Photograph: Ben Stansall/AFP/Getty Images

Although, arguably, local government has contributed more to the health of the nation over the last century than the NHS itself, the relationship between these two public service silos has often been troubled.

The currency of power and responsibilities has been one-way traffic: in 1974, large swathes of health provision that had remained with local government, including public health, moved across to the NHS as part of a huge reorganisation of both services. As medical journal the Lancet put it, running health services was "too important to be left to the local citizenry".

However, in 2013 the tide has turned. The government's NHS reforms see public health returned to its home in local government and local authorities are given a new leadership role through the creation of health and wellbeing boards, charged with promoting integrated services and setting local strategies for health and wellbeing. So will 2013 be a watershed moment in the relationship between the NHS and local government ?

Our latest research is encouraging. Relationships between councils and clinical commissioning groups are generally good, and getting better. The new health and wellbeing boards are investing time in developing relationships and joint strategies are in place. But these are early days and three key questions remain.

The first is how far councils will support NHS partners in driving through essential changes in how local services are delivered.

Our hospitals cannot do everything, everywhere, all of the time. Controversial local proposals expose deep cultural differences between the two services. Local politics is coloured by the evidence of local public feeling rather than randomised trials. This makes it hard for local politicians to lead public opinion rather than follow it. And tougher still when the case for change is not well made and seems to be about saving money not lives. The culture of local accountability of councillors through elections is a source of mistrust and suspicion among NHS managers – though they are well-used to the no-less-political interventions of Westminster politicians.

The second is about money and whether austerity will either provide the burning platform for change or stress test local relationships to destruction. This will play out differently; places with tradition of good local relationships have a better chance of weathering the financial storm. It raises questions about whether the architecture of local public services is sustainable. Do the one million people of the shire county I was working in recently really need 25 different public bodies to deliver their health and social care services?

The pattern of clinical commissioning groups and district councils does not look sustainable but the politics of local government boundaries are tricky and there's no appetite for more reorganisation.

The third issue is whether local authorities and the NHS can achieve a breakthrough in offering the kind of well-coordinated, integrated care that almost everyone agrees is vital . Unless they can deliver more of this on a daily basis with services driven by the clock not the calendar, hospitals and the care system will fall over. Local partnerships alone will not be enough. Though the recently announced £3.8bn integration fund will help, there are some deep-seated fault lines in national policy for health and social care and the King's Fund has established the Barker commission to consider a different way of establishing our entitlement to these services and how this could be funded. The commission has put out a call for evidence, and we welcome contributions.

Our research indicates that although the new boards have set themselves some laudable objectives for local health improvement, it is far from clear whether they have begun to grapple with these three big challenges of money, cultures and ways of working. Local government and the NHS are on a new journey but there is a long way to go.

Richard Humphries is assistant director of policy at the King's Fund.

• Want your say? Email sarah.marsh@theguardian.com to suggest contributions to the network.

Not already a member? Join us now for more comment, analysis and the latest job opportunities in local government.

View the original article here