Public Sector Focus

28.08.17

Who is health devolution for?

Source: PSE Aug/Sept 2017

The general consensus in local government is that health localism is a force for good. But have we taken a moment to listen to the voices of the people outside town halls? PSE reports.

Simon Stevens is one of the few national health leaders who spent a chunk of his career working as a councillor. Perhaps due to his days at the London Borough of Lambeth, where he represented a number of housing estates in Brixton, he now feels personally as well as professionally attuned to the contributions local government brings to healthcare. Just as the N in NHS stands for ‘national’, Stevens believes it doubles-up as ‘neighbourhood’ – or, in Whitehall jargon, ‘integrated and place-based decision-making’.

But despite the need for unity, the NHS England boss argues we’re already “beyond happy talk”. While this doesn’t equate to “talking ourselves into depression”, it does mean that under the financially restrained situation we find ourselves in, the only solution is for health bodies and local authorities to engage in what Stevens calls “practical talk”.

Local authority leaders seem to be in agreement. Speaking as part of a panel on health localism at Confed17, Cllr Linda Thomas, deputy leader of Bolton Council and vice-chair of the LGA’s Community Wellbeing Board, said local government is built on consensus.

“We’ve been consistently amongst champions of local place-based solutions, and that’s why we’ve been calling for local freedoms and flexibility,” she said, underlining the importance of shared cross-sector leadership to make use of the devolved powersin GM. “There has to be a shared vision and narrative on how devolution will help you.”

In Greater Manchester, for example, Cllr Thomas and the rest of the team have confirmed the importance of rich data intelligence, efficient resource deployment and shared performance targets, all of which rely on communication between the NHS and the region’s 10 councils. “We [councils] need to be there at the start of decisions – you can’t just bring us in as an afterthought once you’ve actually made the decisions,” she emphasised.

Also at the panel, Welsh health secretary Vaughan Gething AM said he has witnessed difficulties in his country where people try to deliver change without bringing along every part of the health and care spectrum, including its users. “You need trusts and clinicians to help you engage the public,” he continued. “It needs to be an active and an honest conversation.”

But are we doing enough to amplify the voices of the people in order to attract support for health localism? Louise Park, associate director of health at Ipsos MORI, argues otherwise. At the panel, she reflected on a 2015 survey from her organisation which found that while there is support for the concept of devolution, awareness levels are quite abysmal.

“You have about three-quarters of the English population who don’t know or have never heard the term devolution, or say they know very little about it and can’t describe what it actually involves,” she explained.

“There’s also something about there not being universal support for the concept of devolution depending on certain policy areas. Health and social care is interesting in that respect, because it’s an area where the public are not as convinced that local decision-making makes as much sense as it would do for subject matters like transport or housing. You have about 44% of the population saying those decisions should be made nationally versus 38% saying locally. When you think about housing, it’s 17% [against devolution].”

As Stevens said at the LGA Conference this year, we must recognise that some health devolution plans – potential hospital closures, for example – will face resistance from local councillors. But if the public aren’t briefed about these changes and given the opportunity to decide for themselves, it’s unlikely localism will amount to anything beyond more of the same: a top-down reconfiguration done to people, not with them.

Comments

There are no comments. Why not be the first?

Add your comment

 

related

public sector executive tv

more videos >

latest public sector news

High Court allows London council to fine and imprison illegal campers

17/08/2018High Court allows London council to fine and imprison illegal campers

A council has successfully obtained a High Court injunction allowing it to use greater powers – from fines and asset seizure to imprisonmen... more >
Northamptonshire report to propose splitting region into two unitaries

17/08/2018Northamptonshire report to propose splitting region into two unitaries

A report on the future of the debt-ridden Northamptonshire region due to be published this afternoon will likely recommend replacing all eight lo... more >
Council forced to apologise after telling ‘intimidating’ football fans they were unwelcome

16/08/2018Council forced to apologise after telling ‘intimidating’ football fans they were unwelcome

A Lancashire council has apologised after sending a letter that stated football fans “will no longer be welcome” in the town centre f... more >

editor's comment

25/10/2017Take a moment to celebrate

Devolution, restructuring and widespread service reform: from a journalist’s perspective, it’s never been a more exciting time to report on the public sector. That’s why I could not be more thrilled to be taking over the reins at PSE at this key juncture. There could not be a feature that more perfectly encapsulates this... read more >

last word

The importance of openness after Grenfell

The importance of openness after Grenfell

Following the recent Grenfell Tower tragedy, Lord Porter, chairman of the LGA, argues that if the public are going to have faith in the safety testing process then everything must be out in the o... more > more last word articles >
149x260 PSE Subscribe button

the raven's daily blog

Don’t horse around! Council finds new home for house-bound pony

13/08/2018Don’t horse around! Council finds new home for house-bound pony

A council that took four years in a legal wrangle to remove a pony from an Isle of Lewis house may have found the four-legged beast a new home. Western Isles council removed Grey Lady Too – a Connemara pony that was taken into the home by pensioner Stephanie Noble on Christmas Eve in 2011 – from its residence in 2014 because i... more >
read more blog posts from 'the raven' >

comment

A new era of opportunity for the north

13/08/2018A new era of opportunity for the north

It’s time to stop seeing transport investment as a nice-to-have: it’s a cut-through catalyst for growth in sectors across the north. ... more >
Council mergers: little gain, less democratic

13/08/2018Council mergers: little gain, less democratic

Dr Linze Schaap, associate professor at the Tilburg Centre for Regional Law and Governance, and Dr Niels Karsten, assistant professor at the Tilb... more >
Creating a council cloud-first approach

13/08/2018Creating a council cloud-first approach

Georgina Maratheftis, programme manager for local government at techUK, makes the case for wider adoption of cloud technology by local authoritie... more >
The strength of districts

13/08/2018The strength of districts

Cllr Isobel Darby, member lead for quality of life at the District Councils’ Network (DCN) and leader of Chiltern District Council, shares ... more >

interviews

Modern policing: the future is bright

06/08/2018Modern policing: the future is bright

SPONSORED INTERVIEW The public sector, and policing in particular, has often been criticised as being slow to adapt to change. But now, says L... more >
Michael King: Time for Ombudsman reform

06/08/2018Michael King: Time for Ombudsman reform

Michael King first joined the Local Government Ombudsman service back in 2004 as deputy ombudsman. At the start of 2017, he was appointed as the ... more >
Helping a city understand itself

06/08/2018Helping a city understand itself

SPONSORED INTERVIEW The urban landscape is changing. How can local authorities keep up with citizen behaviour? Stephen Leece, managing directo... more >
Data at the heart of digital transformation

03/04/2018Data at the heart of digital transformation

SPONSORED INTERVIEW Grant Caley, UK & Ireland chief technologist at NetApp, speaks to PSE’s Luana Salles about the benefits of movin... more >