Councils best placed to revitalise the NHS

What a relief to know that this is the “best year ever” for the NHS. While this might be arguable in performance terms, it seems scant consolation to some of the 7,000 NHS workers who have so far lost their jobs, which led to the health secretary Patricia Hewitt being heckled by angry delegates when she addressed Unison and the Royal College of Nursing.

Neither speech by Hewitt made any reference to social care, so we have no way of knowing whether the government believes this is the best year ever for social care or not.

Meanwhile, NHS deficits and job losses are having a knock-on effect on social care. With the departure of Ray Jones from his job as director of Wiltshire social services, where he was an early pioneer of integrated working, we have the first major casualty of the cuts. With the NHS reportedly withdrawing 3m at 14 hours’ notice, Jones rightly said enough is enough. How can we work in partnership, he is quoted as saying, when one party can “take their ball home?”

Only a few months on from the Our Health, Our Care, Our Say  white paper things seem in a sorry state and genuine health and social care partnership seems as elusive as ever.

But if we are serious about joining up services, then perhaps this is the time for a new and more radical approach. For years we have acknowledged that the health and social care divide is a problem and tinkered around the edges.

While there have been some positive developments at the centre, much has been left to local discretion and the bulk of progress has relied on local partnership enthusiasts to make the system work. With the NHS in financial difficulty – “creative discomfort” is the official term – the time seems right to reignite the debate about local authority-led health care.

What would the world look like if we transferred health care commissioning to local government, leaving PCTs as provider trusts?

First, we would have genuinely integrated commissioning of health and social care (as well as achieving the separation of commissioning and provision that is so central to current NHS reorganisation).

Second, we would have more chance of reducing financial deficits – for all their faults, social services departments have become expert at managing scarce resources and the seemingly unlimited demand to come in on budget -or at least a lot closer than the NHS. Social care also has extensive experience of commissioning from a mixed economy of care. This is something the NHS is being asked to do but has little track record in this area.

Third, it would be an opportunity to move away from the traditional focus of the NHS on curing disease towards a more preventive system focused on well-being. Public health has always sat uneasily within the acute care-dominated NHS, and its natural home must surely be in councils with their greater emphasis on community leadership and well-being.

Finally, it would democratise local NHS services and increase interest in local politics. For all the talk of patient and public involvement, the NHS remains professionally dominated and difficult to hold to account at a local level. Transferring powers to local government would reverse this and give local people greater say in how local services are run.

Of course, none of this is likely to happen. When financial problems hit, we work even harder by doing more of the same (without recognising that it was more of the same that got us in this mess in the first place).

It might also be unpopular, with NHS workers in particular, and the health secretary would undoubtedly get heckled even more. But despite all this it might be the right thing to do, and isn’t that what political leaders are there for?

Jon Glasby is a health and social care policy analyst and a board member of the Social Care Institute for Excellence

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