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Richard Hills

It’s complicated (part II): Why councils need to keep contributing to STPs

STP Part 2

For local authorities, STP process has been frustrating. There has been the usual lack of engagement by some of the less progressive CCGs with both councils and the wider public (the latter at the behest of NHS England).

Does this mean councils should walk away defeated? Certainly not. And here’s why:

  • The Better Care Fund, as well as previous funding arrangements, means local authorities are more reliant than ever on health contributions to prop-up long suffering social care budgets. It will hurt councils more than it will CCGs in the short term to walk away from the progress made so far towards integration, however small.
  • Although the focus has shifted to what to do about acute overspends, it was never NHS England’s intention that CCGs ignore council partners. The Operational Planning Guidance is clear  about LA involvement in its latest attempt at transforming health care.
  • The nine ‘must dos’ that NHS England expect to see delivered by CCGs over the next two years include a focus on Learning Disabilities, Mental health and Urgent and Emergency Care, all areas which will have impact on local authority budgets.  Objectives set out in the most recent Guidance such as ‘establishing post-diagnostic care and support for people with dementia’ and ‘enhancing community provision for people with learning disabilities and/or autism’ all require input and resource from local authorities to deliver.
  • Both CCGs and local authorities are looking to use demand management and preventative services to realign their systems from reactive to proactive models of care. Both are likely to find public resistance if they cannot come together to deliver a co-ordinated and joined-up argument that makes sense to their residents, and both will lose out on much need efficiencies if they don’t.

Local authorities need to instead take the position set out in the Operational Planning Guidance  seriously using Health Scrutiny Committee’s, Health and Wellbeing Board’s and their existing senior relationships to continue to have a proactive role in the ambitions set out in the NHS Five Year Forward View.

It’s time for integration to take centre stage and that means working together on STPs, no matter how imperfect the process.

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