2nd June 2016
Health and Social Care Transformation
Up and down the country Local Authorities will be engaging with their partners on a new and recent entry to the Local Government lexicon which is of course STPs. STPs are Sustainability and Transformation Plan submissions which NHS health partners are required under their governance to submit. Two things are clear; our health partners are under significant stress and STPs are a real test of partnership working. It was, therefore, good to see Mark Lloyd and Simon Stephens working together on this at a national level.
Strategically, getting health onto a sustainable footing is in everyone’s interest and I have been mightily impressed with so many examples of strong local partnership working including the way, say, our own Cheshire Fire and Rescue service has already stepped forward and begun trying to combine visits that fire officers would do with other preventive advice and information which will benefit health organisations. This preventative work is wholly supported by all partners on the patch. Across the Country, health providers which have perhaps otherwise been competing are
now exploring collaboration. For some, this is a natural extension of work already undertaken or planned for. For others, this is perhaps newer territory.
The speed, therefore, of the STP will advantage those areas with natural geographies and recognised boundaries which have been in place for a long time; other areas which are on less traditional footprints may end up having to play catch up. What is evident is that, given we all want a sustainable solution to health and the sector is going through a significant budget challenge, Local Authorities have experienced this in recent years and their learning could prove vital in guiding the process.
For decades, Local Authorities have also experienced the “freedom” of simple rules, particularly regarding budgetary certainty. Even in the current harsh financial climate, Local Authorities know that overspending their total budget is not accepted; they know exceeding their savings will allow local choices. With this in mind, an important question for this should be; are our health partners genuinely incentivised to reduce their costs? After working extremely hard to improve efficiency and outcomes, do they get to keep their savings and plough them back into local prevention
initiatives or, are the monies re-allocated to areas of higher demand?
Another simple rule I recall is how the LGA and Solace worked hard to ensure some years ago the “new burden” rules. This is sometimes overlooked but the principle that central government could not create “new standards or demand” on Local Authorities without being clear on the financing of them, was a very elegant and simple solution which has stood the test of time. A sustainable system must have sustainable incentives and encourage a wholesome and sustainable discipline on public finance. I also recall that rigorous pursuit and enforcement of national standards across the whole of local government, irrespective of local circumstance, came to an end (accepting in the children’s area which everybody agreed was right at the time).
This did not, as was feared, create a race to the bottom, on the contrary, general service standards went up for those services that were retained. Statutory partners like the Police, Fire, all tiers of local government and our vitally important third sector understand the importance of local democracy and have got used to a more devolved environment. Dealing with health partners who work in a comparatively more hierarchical way with central command, is a reminder of recent times past. What is clear is that flourishing communities able to access economic prosperity need a strong, locally accountable and financially sustainable health system. After witnessing strong local leadership on a day to day basis, I am confident that, through innovation, collaboration and a simplified system of incentives, local partnerships will overcome these testing times and deliver for our communities.
By Mike Suarez, Chief Executive, Cheshire East Council and Solace Deputy Spokesperson, Local Government Finance