As a response to the fragmented system left after the Health and Social Care Act reforms, however, the emphasis on ‘place-based’ working offers local authorities and their NHS partners an opportunity to work together to achieve better outcomes for their populations, shifting the system towards prevention and taking a system-wide, not service-led, approach.
Integration and collaboration are not in themselves the prize. Instead they may be the only way to transform systems and cultures created in a very different era for very different demands.
Roy Lilley, occasionally controversial but always thought provoking, wrote recently:
‘STPs can’t deal with demand, they can only play with the flow created by demand. Demand is too far upstream for NHS dominated STPs to deal with: housing, work, the environment, diet, lifestyle, poverty, education.’
When you unpack this comment it covers many of the challenges faced by STPs. It also hints at some of the benefits that can be reaped by working in partnership to ensure the plan is clearly aimed at ‘a good life for all’, rather than simply reforming existing services. There is no doubt that, without change, both the NHS and local government will continue to need more and more resources. Struggling on heroically in the face of ever-increasing demand is unlikely to address this. Hospital admissions continue to rise (up 3.6% between 2003/4 and 2015/16) and yet NHS budgets are increasing by little more than 1% year on year; and Council budgets are rapidly decreasing, with a an 8% real-terms cut in adult social care spending between 2009/10 and 2015/16. Simply focusing on budget cuts will fail to deliver the long-term sustainable change that we need.
Local authorities have the opportunity to work with the NHS to support and encourage it to embrace a whole-systems approach and the impact STPs could have on the wider social determinants that create good health. This aligns with local authority priorities around ‘good growth’; reducing poverty and increasing community resilience and capacity. Our STP in Wakefield, for example, makes a specific commitment to realigning the system to move resources towards preventative activity, with detailed work streams to support this.
The King’s Fund has described at length how integrated care, whilst being a key focus of NHS reform, has rarely extended its reach into the broader health needs of local populations. Is this a missed opportunity? Initiatives which are able to demonstrate real improvements in the health of the population, such as the Kaiser Permanente health care system in the USA, have a remit way beyond simply providing healthcare and focus also on improving access to green space, educational theatre programmes for children and employment programmes. This is what our Local Authorities have been doing for decades.
This is not a time for criticising from the sidelines. It is crucial that we all take a seat at the table and realise the opportunity to lead conversations that should have happened before. There is a major leadership role for local members and officers, bringing a democratic mandate and strong citizen focus to the evolving STP process.
 Ref: Lilley, R ‘Stop, think, please…News and Comments from Roy Lilley nhsmanagers.net 5/09/2018