I’m involved in system change in two key ways. First, as Chief Executive of Leicestershire County Council and second as a member of the Department of Health’s Local Government Programme Board. Over the coming months I’ll share my reflections on these two different roles, how they differ and where they interact.
In Leicestershire, we’ve responded positively to the changes set out by the coalition. That’s not to say we don’t recognise the scale of the change. But what makes us excited is the impact is should have for local people in terms of service; the fact local democratic leadership will now be played across a wider field of health and social care; and the transfer of public health to local government is a particularly tangible sign of an early win for all of us working in local communities.
The opportunities are compelling – we’re helping to create a health system that’s more open and accountable, both in the way health care is delivered and in the way elected and patient representatives will get to have their say in decisions.
That’s not to say these changes are not without challenges. There are major areas for our attention. For example, we need to set up and sustain a new form of partnership working under local government’s leadership, and as part of that recognising that GPs may find or continue to find partnership working under the leadership of the local authority a new and different experience.
Beyond the cultural challenges, this is about massive organisational change. Public health coming into local government is not just about a transfer of staff but is about recognising that good health is at the heart of any place-based approach to public service reform. Because health and well-being interacts across most service areas it will also have a big impact on local government’s role as a commissioner across a wide range of services.
In developing the plans we’re all now responding to, my experience is that DH has been very open. I’m pleased to represent local government and enable local government to have a direct say through sitting on the Programme Board, and also acting in an advisory capacity on a reference group, established to ensure genuine engagement with local government across all aspects of system change. It’s also good that DH is involving elected representatives in their transition planning. My take from working with DH, is that they and our NHS partners know the degree of change required is not possible and will not be successful unless we all work together – that’s what’s happened in practice.
I’d like to finish by reflecting on where I’d like to be a few years down the line. From the council’s perspective – I want to see us much more involved in decision making on health and social care and that there is sensible and effective integration and commissioning. More importantly, I want local people to see improvements in healthcare and their own health and wellbeing, but also improved patient experience in their interactions with different healthcare providers.
Once we’ve achieved those two main goals, it will be interesting to look back and see how much of the current structure has changed, how much has disappeared and how much has reinvented itself.