It is “inevitable” that local authorities and the NHS will pool their public health budgets to get better value for money – and better outcomes for patients.
That was the verdict of the Lancashire County Council cabinet member who made just such an offer to the health service in the region earlier this summer – but it is still waiting for it to be taken up.
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County Coun Shaun Turner, the member for health and wellbeing, admitted that his proposal was “never going to be simple”, but that it was the “direction of travel” across the whole country.
“There is a lot of discussion [at the moment] about sharing risks and rewards – that’s where the benefits of spending by one organisation can be felt by another,” County Coun Turner explained.
“For instance, a county council spend might have a positive outcome for the NHS. [We need to consider] how we capture those benefits and share them equally amongst us.
The offer to pool budgets across the organisational divide came against the backdrop of County Hall making £4.1m of savings from its own public health pot – with healthy weight services, rehabilitation programmes and early intervention schemes for those with social and mental health problems all cut back.
At the time of that decision in June, the authority claimed that closer working with the health service could bridge the gap left behind by reductions in council-run services.
But a recent meeting of the Lancashire health and wellbeing board heard that the county’s NHS clinical commissioning groups (CCGs) wanted clarification of exactly what was being proposed before signing up.
“There have been different interpretations of what the offer represents – from joint decision-making about how public health budgets are spent to devolving budgets to Lancashire’s Integrated Care Partnerships [five sub-regional collaborative bodies incorporating councils and the NHS], said Clare Platt, Lancashire County Council's head of health equity, welfare and partnerships.
“I think there is some work to do from the county council’s perspective in firming up…a more formal understanding – but the CCGs we have spoken to so far are keen to work in a more collaborative way.”
However, County Coun Turner says he is still confident that an agreement will be in place before any of the county council’s public health programmes are reduced or ended.
“Once there is a real accountability and governance – we can ask any parts of the system which are underperforming why they haven’t done [whatever] they should have done according to the agreement.
“Only then, when the signatures are on the page, do I believe you’ll see behaviour change among organisations.
“You’re talking about vast organisations coming together – and there are internal walls within those organisations as well.”
But County Coun Turner says he is optimistic that a move towards commissioning more community-based services at a “neighbourhood” level will be a catalyst to change entrenched attitudes about finances in the public sector.
“There are all sorts of things going on [involving] partners in the wider field, like care homes and in the third sector. They are discovering things which they never knew were happening in their own areas and things which other groups are doing.
“We really need to [bridge] the gaps and produce a better service.”