30th September 2018
Without local government, the NHS will never understand its true value
One of the great ironies of the ‘place’ agenda is that while we may be heading towards the same point we are taking very different routes and for very different reasons. Perhaps this doesn’t matter, but it helps to understand our respective Satnav’s intentions.
Let’s start with the very concept of place. For many councils the ability to determine which, if any, combined authority they feel an identity with is critical – so much so that it could make or break well established local partnerships. With Sustainability and Transformation Partnerships (STPs) on the other hand, it sometimes appears England has been crudely divvied up from a darkened room in London, with places all told to get on with working together whether they feel a local connection or not.
And for now, this does matter.
The ‘place’ agenda, when seen from the top and through purely sectoral eyes, does not particularly focus on local relationships. In the NHS money is power and it’s not too outlandish to view sub-regional collaborations as simply another opportunity for those at the centre to exercise greater control in a world of diminishing financial returns. If cost has largely driven the place agenda in health and care to date, we need to start focusing on the value.
The links between the health service and the local economy are often to be found hiding in plain sight. One of the largest employers, procurers, and landowners in every part of the country, a key part of the local innovation architecture and a clear driver of local productivity through increased levels of health and wellbeing. A service built on large anchor institutions wielding significant economic power in every town and city.
While it might seem odd perhaps that, despite the focus on place, the NHS doesn’t shout about this local value its worth again remembering the system view. Our economic impact is not something that nationally is measured, encouraged or supported. Thus the local externalities of our economic decision-making – positive or negative – do not factor into many board-level discussions.
As local authorities grapple with the challenge of growing their own local economy this NHS value – both economic and social – becomes more important, and its omission from local plans more glaring.
At present, I am supporting several STP and ICS footprints across England to align their priorities and plans with the emerging local economic and inclusive growth agenda. Skills, employability, innovation, infrastructure, housing, inequalities, prosperity – all critical issues where there is a strong and shared local interest in realising our place’s potential.
Starting a conversation with local government that is not solely related to social care isn’t an easy step for many in the service. There is still a nervousness amongst NHS leaders in engaging outside their traditional ‘core’ areas, and this certainly includes local growth. Some of this is cultural given years of ‘command and control’; for others perhaps they do not feel entirely comfortable with the competitive nature of local economic development. I do detect, though, an increasing understanding that it needs to happen.
And this, in my view, presents an opportunity for local government to lead the next stage of STP and ICS progression. As system development becomes place development our attention turns to the collective sum of the individual parts. The value of the local NHS needs to be both understood and unlocked, and in my experience that can only be done from outside the sector.
The NHS needs local authorities to spell out the benefits of supporting local SMEs to compete for contracts (and conversely the dangers of paying local suppliers late). Similarly, the value of our land and assets to local partners (other than estate agents) is not something that routinely surfaces in our discussions. Who exactly benefits from an expanded NHS use of the Social Value Act and why does this matter? What businesses are partners trying to attract locally that might want to work with us in the NHS? What is inclusive growth and what is our role in it?
Transforming the public service offering across a locality while at the same time growing an economy that works for all its parts is an extremely delicate balancing act. Having a health service involved in discussions about how a local area raises money, rather than simply how it spends it, should be seen as a necessary part of this.
As we move forward it’s very possible that the more the NHS understands ‘place’, the less it depends on the centre. This brings a host of local opportunities for new ways of working. We can debate whether or not this was the intention when the policy was developed, at some point London will be behind us in the distance and this won’t matter.
by Michael Wood, Local Growth Advisor at the NHS Confederation
Michael Wood is Local Growth Advisor at the NHS Confederation. Follow him at @NHSLocalGrowth