Councils best placed coordinate local health systems, says report

Today, the Local Government Information Unit (LGIU) published their latest report, Local Health Systems: Relationships not structures, which argues that councils are best placed coordinate local health systems.

The report, which is sponsored by Browne Jacobson and includes expert input from the firm’s government sector lawyers, James Arrowsmith and Anja Beriro, finds that improved long term outcomes across communities will require a step change in the role that councils play within local systems for health.

It says that in order to do this, both renewed local leadership and an adequate supply of funding is needed. The aim of thinking about local government in terms of systems is to build a more connected approach across places that drives towards a set of coherent and mutually supportive social and policy outcomes.

Based on interviews with council officers in three areas across England, this report shows that there is huge potential for system wide partnerships, especially following the Covid-19 pandemic. It found that there is a widespread appreciation of the value of system-based policy, of partnerships, risk taking and innovation. Yet these often do not play out in practice. In order to support change in these two areas, the report’s key recommendations include: making sure that all partners’ strategic documents are aligned across the system; working closely with citizens; balancing risk; creating the conditions for behaviour change; system-wide budgeting and capacity building.

Jonathan Carr-West, Chief Executive, LGIU said: “Good local health systems depend on relationships of trust, transparency and cooperation. Yet the focus of systems thinking is often structures and processes, rather than people and relationships.

“As the local elected institution, with a remit for providing a wide range of services and establishing connections between citizens and the state, councils are best placed to bring coordination to local health systems. However, chronic issues around funding and capacity hamper their efforts to act as leaders.

“To move forward on this agenda, leaders need to provide the right framework and incentives for staff to innovate. New approaches and collaborations can entail risks that things won’t work and we need to create the conditions for trust and collaboration, aligning incentives and performance indicators accordingly so that staff feel safe enough to look around them, taking a system-wide view of the work that they do.

But system change and behaviour change cannot be done on a shoestring. Capacity is already stretched in local government and in the NHS. We need to move on from the piecemeal, ad hoc and short-term patchwork of ring-fenced pots that Whitehall makes available to councils for capital spending and provide decent, sustainable funding for local government. Additional responsibilities for long-term strategy and partnership building should not impose greater demand on local authorities without proper support.

“Ultimately, devolution and levelling up will only be meaningful if local government is enabled to develop its capacity and given the support it needs to lead locally.”

James Arrowsmith, Partner, Browne Jacobson, said: “We are delighted to have partnered with the LGiU on this insightful report, highlighting the integral role that local government can and should play in positively shaping the future health and care landscape. The report concludes that through better collaboration and effective system leadership, great things can be achieved.

“In recent years, we at Browne Jacobson have consistently heard the same message from our own client base of health bodies and local government organisations, that the role of local government as an equal partner in systems is not being achieved. But there is ample evidence of a desire to remedy this and strive for integrated partnership working. This report presents the myriad of opportunities to do so. Having truly integrated care systems that are understood by those operating in them and the communities using them will be key to delivering successful outcomes for all.”