The Health and Social Care Bill is set to make fundamental changes to the NHS; changes which most within the Labour Party, do not want, and do not support. But, nestled within the Bill are a series of reforms which could have a radical and positive impact for Labour in local government. This leaves Labour authorities with difficult choices: reconciling potential tensions with the Bill at local and national levels, whilst making significant decisions about the future of health and social care in their areas.
At a local level, changes as set out in the Bill have been underway for months; Primary Care Trusts have clustered, many local authorities have adopted shadow Health and Wellbeing Boards and Clinical Commissioning Groups have established. These local level changes have been happening, irrespective of opposition, partly due to timescales, but also because at local level some of the changes set out in the Bill are welcomed by local government – on the Right and the Left. The current system across local government and health is disjointed, and could benefit from change. Labour local authorities recognise this.
Surely Labour councils are right to look at how they can strengthen their role in tackling health inequalities locally? So while this this argument is about values and is highly emotive, we shouldn’t ignore the fact that there is need for change and progress around health and social care in local government – and Labour will want to support their local authorities in making progress on this.
The most significant change proposed for local authorities is the transfer of public health and health improvement responsibilities from PCTs to local government; commissioning of public health services will transfer to local authorities. Many local authorities, including Labour authorities, have long argued that local government should have greater influence over public health. The strengthened role in ensuring greater integrated working between health and all parts of local government is also critical.
By now, most local authorities will have established ‘shadow’ Health and Wellbeing Boards – you don’t need legislation to do this. The Boards will enable local authorities to have substantial influence and responsibility over public health and joint working, and will strengthen the role of local authorities in tackling health inequalities. Because of the tight timetable around implementation of the Bill (April 2013) if local authorities are not already acting, structures would not be in place in time and would risk the National Commissioning Board taking on local commissioning – which would take powers and influence away from the local level. This hasn’t really given a choice but to press ahead with the changes now.
This all sounds positive. Labour have a growing base of power in local government, and these additional responsibilities would give councillors a stronger role and authorities real levers to make reforms locally that could positively change the lives of many. In the run up to the next general election, the Party will want to demonstrate where Labour in local government has made a real difference and local improvement in health and health inequalities. These changes could enable this.
If it is the case that the changes in the Bill for local government are positive and pressing ahead, why is there still so much opposition, even at the local level?
For all of the changes outlined above, you do not need legislation. You don’t need the Bill to promote integrated working, undertake joint commissioning (on an informal basis), or develop joint wellbeing strategies with health professionals. Without the Bill, these provisions for local government alone would be welcome. But, the problem facing Labour local government is that you can’t look at this and the new responsibilities without looking at the wider context.
The Bill will fundamentally change the NHS. Everything regarding health at the local level, including the Health and Wellbeing Boards, will be impacted upon by these changes. For local authorities, making a success of these new responsibilities around health and wellbeing will be much more difficult because of these changes to the NHS. Not least because the National Commissioning Boards will be influenced by rules on competition, which will make integration between these agendas difficult, but also because this fundamentally tests Labour founding principles around the NHS.
Laura Wilkes is a Policy Manager at Local Government Information Unit. She writes here in a personal capacity.