“Councils have turned on the NHS over “secretive, opaque and top-down” reforms that they say will fail patients.
Simon Stevens, chief executive of NHS England, has staked his tenure on co-ordinating care more effectively and has said that local authorities are crucial to the process because they oversee public health and social care for the elderly.
However, only a fifth of councils think the plans will succeed amid widespread complaints that they have been shut out of the process by the NHS, according to a survey by the Local Government Association.
Not one councillor who responded said they had been very involved in drawing up plans and nine out of ten said the process had been driven from Whitehall rather than locally. Cultural clashes with a “command and control” NHS that did not trust elected councillors meant that more local authorities believed the process was harming social care than helping it.
Mr Stevens has created 44 “sustainability and transformation partnerships” (STPs) where hospitals and GPs are meant to plan with councils on how to improve care and help close a £22 billion black hole in the NHS budget. However, four out of five councillors said the system was not fit for purpose and criticised the NHS for prioritising cost-cutting and closing hospital units over preventing illness.
Izzi Seccombe of the Local Government Association said: “Many councillors have been disappointed by the unilateral top-down approach of the NHS in some of the STP areas. As our survey results show, the majority of local politicians who responded feel excluded from the planning process. If local politicians and communities are not engaged then we have serious doubt over whether STPs will deliver.”
Half the 152 councils with social care responsibilities responded to the survey and 81 councillors with responsibility for health contributed. “The way in which the STP has been handled (top down, secretive, lack of engagement) has harmed relationships between the council and some NHS colleagues,” one said.
The NHS simply does not understand the decision-making of local government
Another said: “It is entirely driven from the top, via budget pressures. The process has been overly secretive and opaque. It has got in the way of closer working between councils and health.”
Councillors criticised STPs as “complex and full of jargon”, saying “the NHS simply does not understand the decision-making of local government”.
Ms Seccombe said that in a centralised NHS, managers often did not want to share information with party political councils accountable to local voters, saying that the process was “trying to mix oil and water”.
Chris Ham, chief executive of the King’s Fund think tank, said: “This survey suggests worrying numbers of council leaders are still frustrated by the process and lacking in confidence in their local plan. A huge effort is now needed to make up lost ground.”
A spokesman for NHS England said: “By creating STPs we have issued a massive open invitation to those parts of local government willing to join forces, while recognising that local politics can sometimes make this harder. The fact that public satisfaction is more than twice as high for the NHS as it is for social care underlines the real pressure on councils. It should serve as a wake-up call to every part of the country about the importance of joint working.”
Source: The Times (paywall)