Councils are becoming increasingly aggressive in their opposition to hospital trust moves such as changing an accident and emergency unit. Photograph: Leon Neal/AFP/Getty ImagesCouncils are becoming increasingly aggressive in their opposition to hospital trust moves, such as changing an accident and emergency unit into a more modest urgent care centre.
In the high court, Lewisham council won a major victory, blocking changes to their local hospital that were part of a plan to save the imploding South London Healthcare Trust.
In west London, Ealing is objecting to changes to A&E services, while down the M4 Windsor and Maidenhead is fighting a plan to move a minor injuries unit to Bracknell and close a birth unit. Trafford council has voted unanimously to fight the closure of the A&E unit at Trafford general hospital, which at peak times see seven patients an hour according to the Department of Health, and expand services nearby.
Councils are taking these actions while they themselves are making similar difficult decisions – closing, downgrading or sharing services, and sometimes handing them over to someone who is doing it better – such as Hampshire county council taking over Isle of Wight's children's services. Is there a whiff of hypocrisy?
Local governments scrutiny of the NHS is often the service's only effective democratic oversight. Foundation trusts have a fig leaf of public accountability through their membership schemes, but there are few trusts who can seriously claim members make much difference.
But councils' local mandate should not be an excuse for hysterical overstatement about what is being proposed. When the high court blocked Ealing's attempt to judicially review the west London accident and emergency reorganisation the council described the GP-led plans as "monstrous", with leader Julian Bell claiming: "The NHS want to treat the people of Ealing as guinea pigs in the largest experiment in its history".
This sort of hyperbole is irresponsible. Spreading the idea that the NHS wants to treat an entire borough's residents in such a way is itself monstrous. It crudely plays on the fears of local people and obliterates the chance of an intelligent discussion about what is being proposed.
Ealing has faced its own tough decisions, such as changes to its services for people with learning disabilities. Surely it must know that everyone loses when debate around reforming – and sometimes simply closing – public services is reduced to invective.
Of course, councils cannot simply abdicate taking a position on something of such profound local interest. On the contrary, if community leadership is to mean anything, it needs to be a vigorous participant in the debate.
But that means actually leading, not unthinkingly following the gut reaction to oppose. It is now clear from Local Government Association analysis that the 2015-16 spending review has left councils facing cuts of up to another 16% – not the 10% that the government stated. If anyone has a vested interest in raising the quality of public debate about how to manage cuts in public services it is local government.
When it comes to their own services, councils are demonstrating a willingness to look at a radical solutions which can offer residents a better service for less money. Trafford is one of them – leading the way in redesigning adult services by championing reablement.
Councils have a duty to scrutinise, question and debate reforms to local health services. Sometimes those proposals will be found wanting – as Lewisham demonstrated. But dogmatic defence of the status quo in defiance of the best long-term interests of patients is a serious error of judgement, even if it may be superficially and tactically appealing.
These difficult discussions between councils and the NHS will be a major feature of local government for the next decade. Attempting to drag proposals through judicial review cannot be the default response. Where that happens it is an indication of failure on both sides. There are numerous examples of where councils and local NHS services have collaborated effectively to make the right, difficult decision.
As the community leaders, councils must be in at the beginning of these debates – helping shape them, questioning them, but also accepting where the evidence leads, and having the courage to support the outcome.
• What do you think? Email sarah.marsh@theguardian.com if you want to contribute an article to this debate.
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