“I can’t argue with some of what Jon Glasby says about the Health and Social Care Bill. Major re-organisations create huge, unproductive upheavals and bring great risks. The NHS has indeed done rather well in recent years, with productivity up and waiting times and hospital acquired infections down.
However, the Health and Social Care Bill does offer some really significant opportunities for doing things differently. Jon highlights the pressures which the NHS is under, including an ageing population, new technologies and increasing expectations. It is those very pressures and the fact that many of the things which influence people’s health – housing, employment, activity levels, aspirations and education - which make it essential to take a fresh look at how we understand health need and allocate resources. We need to move away from an emphasis on hospital based diagnosis and treatment to more holistic approaches to prevention, early intervention and the management of chronic diseases.
The Coalition Government has heralded a real change by giving local authorities the responsibility to ‘hold the ring’, through the Health and Wellbeing Boards (PDF - 238KB), between public health, adult social care and the NHS (through Clinical Commissioning Groups). Cynics may say that central government is doing what it always does – relying on local agencies to make sense at a local level of those policies which it has failed to join up at a national level. The separate development of three different frameworks for public health, adult social care and the NHS would certainly support that cynical view.
However, the Health and Social Care Bill does provide opportunities to do some things better, which many local authorities are already using for the benefit of their communities. Health and Wellbeing Boards bring some local democratic accountability to assessment of need and the allocation of increasingly scarce resources to deliver more positive outcomes. The integration of public health into local authorities will give that service a longer reach and greater influence for the benefit of local communities.
INLOGOV is working with a number of local authorities on the integration of public health and the development of Health and Wellbeing Boards. The response of this has been very heartening, with little cynicism and much enthusiasm for doing thing differently and better – as evidenced by the almost universal sign-up to the ‘early implementers’ programme. Our clients are already working with partners, particularly the new Clinical Commissioning Groups, to take a radical look at how different parts of the health and social care system can work together better, to understand the interventions that work and to streamline fragmented services and tackle the complex, intractable and expensive issues such as alcohol, which cost us all so much.
It isn’t going to be easy. The challenges are enormous, with a health and social care system of mind-numbing complexity and the difficulty of doing anything new in a time of great financial stringency . But the local authorities we are working with welcome the challenge because the potential gains for their communities are so great. Health and Wellbeing Boards won’t generate many headlines . Their heroes will be largely unsung. But the leadership of local authorities and the commitment of their partners may hold the key to the future success of an effective local health and social care system and a sustainable NHS."