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Local government and the NHS have enjoyed a mixed and, at times, tempestuous relationship over the years.   It is easy to forget that until the creation of the NHS in 1948, local authorities were responsible for three out of four hospital beds and until 1974 they ran most community health services, with every council having its own medical officer of health

Whereas past NHS shake-ups left local government with fewer responsibilities, the 2012 Health and social Care Act actually strengthens its role.

One of the most striking features of the government’s reforms has turned out to be the least controversial and most widely supported - the creation of new local health and wellbeing boards. They are designed to boost local democratic legitimacy in the NHS by bringing together health leaders with key people in local authorities, including elected members, to plan and coordinate local services. This led them to be described as ‘the crucible of integrated care’ by the NHS Future Forum.

The remit of the Boards will go beyond the narrow issue of how to join up health and social care and address the wider social determinants of health and wellbeing . Our recent research shows that local authorities are taking their new responsibilities very seriously and have brought new energy and purpose to traditional - and in many places tired - relationships. With the NHS and local government having fundamentally different systems of governance, accountability and funding, there will always be a need for some kind of mechanism for bringing together the key players whose cooperation is essential for people whose need straddle different boundaries and budgets. But this kind of partnership working is not easy and the evidence base for success is disappointingly thin.

The new Boards begin their life in the most hostile financial climate in living memory, with the NHS needing to find £20bn in productivity improvements and local government cuts of 28 per cent over the current spending review period. This will generate tough and controversial choices for commissioners, including closure or reconfiguration of valued local services where it will be difficult for local authorities – who host and usually lead the new Boards – to sit on the sidelines.  This will be a critical test of these new local partnerships, especially when clinical commissioning groups are also finding their feet.

There will also be tensions in reconciling the localist credentials of the Boards and national priorities and pressures, not least from the NHS Commissioning Board.  But there is almost universal agreement that the years of austerity that lie ahead demand collaboration.

Existing patterns of investment -  based on traditional notions of people getting ill, being treated in hospital and discharged – no longer correspond to escalating levels of long term conditions and an ageing population needing care that is coordinated across different professional disciplines, services and interventions. Integrated care is the key to unlocking this and there is nowhere else in the complex structural organogram emerging from the health reforms that brings together the principal players.  Although the odds appear to be stacked against them, early evidence is encouraging, suggesting that health and wellbeing boards are well placed to deliver the local system leadership on which integrated care depends.

Written by Richard Humphries
Friday, 27 April 2012 9:09

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