With councils and the NHS at loggerheads, vital services are at risk

Who should run local health and care services, especially public health services, is becoming an increasingly tense battleground between the NHS and local government, with serious potential consequences.

The NHS long-term plan, unveiled in January, aims to deliver the “triple integration” of primary and hospital care, physical and mental health services and health with social care. From councils’ point of view, this is a unique opportunity to fix one of the big flaws in the way the NHS was set up in 1948, with a centralised service telling local services what to do, rather than focusing on the needs of local communities.

With NHS community and mental health services – especially mental health care for children and adolescents – set to be the big winners in the scramble for funding for at least the next five years, local NHS services and councils have a chance to focus on tackling the root causes of physical and mental illness in their area.

The NHS plan wisely avoids setting out precisely how this local collaboration should happen, putting the onus on local leaders to find ways to work together. Some are struggling. A mix of honest policy differences and less laudable clashes of ego have caused serious disputes in some parts of the country.

As the Heath Service Journal reports, Luton borough council has quit the Bedfordshire, Luton and Milton Keynes integrated care system (these are the bodies being set up across England to integrate services), alleging it has been sidelined. Two other councils had previously threatened to quit the same organisation.

Nottingham city council has suspended its involvement in the integrated care system covering Nottinghamshire, claiming a lack of local accountability. Relations are fraught in several other parts of the country.

Like Brexit negotiations in miniature, some people would prefer to walk away, or refuse to budge while accusing the other side of intransigence, rather than take on the hard graft of arguing through difficulties to find a solution.

Meanwhile the growing dispute over the future of public health services threatens to undermine the most positive part of the infamous 2013 NHS reforms – moving responsibility for public health to local government.

According to the King’s Fund, government cuts meant councils’ spending on public health services was 8% lower in 2017-18 than 2013-14. The cuts continue in the coming year. The big losers have been drug and alcohol services for both adults and children, sexual health services and smoking cessation.

Without consulting local public health directors, the NHS plan proposed that the health service would take a bigger role in commissioning sexual health services, health visitors and school nurses.

The Local Government Association highlights official data showing that many public health indicators are heading in the right direction, such as falling teenage pregnancies and abortions, continuing falls in smoking rates, less drug use and a steady decrease in suicides as the rate among men drops.

The figures do not prove that local government is responsible for those falls, but they do at least demonstrate there has been good progress while councils have been in charge. As Jim McManus, director of public health at Hertfordshire county council, points out, local government’s performance compares well with similar services commissioned by NHS England, such as prison health, immunisation and cervical and breast cancer screening.

Public health doesn’t need to be reorganised yet again, it just needs to be funded properly. Ripping it out of local government after just six years would harm services and undermine relationships between the NHS and councils just as they should be pulling together to deliver the ambitions of the long-term plan.

And council leaders should have the confidence and commitment to remain full players in the leadership of local health and care services, no matter what the short-term difficulties.

• Richard Vize is a public policy commentator and analyst