Ever since I can remember there have been different world views over what is important between the NHS and Local Government. This article exemplifies this and reflects both political legitimacy ( one based on General Elections and one based on Local Elections) as well as the separate funding silos. In any democratic society if these two factors are distinctly different and remain so, there is very little organisational drive or purpose in them joining up, even if that is clearly in the interest of the public.
Ultimately organisationally hierarchies will always make sure that their organisation benefits/is not disadvantaged too much, by any change. There are in my view only really two solutions to this. Either a) Local Government takes over responsibility for all health and social care commissioning or b) we develop a national care service with its own funding stream. Nearly 70 years since the NHS was founded- there is little to suggest that collaboration will work in a way that meets public demands or political expectations, whatever the empirical evidence about its benefits.
Simon Stevens has been one of the best friends local government has ever had at the top of the health service. His Five Year Forward View, launched in autumn 2014 just six months after he took up the role, was firmly localist in perspective. It moved away from veneration of a single uniform model of health and care services across the country to a recognition and acceptance that different places have different geographies, assets and characteristics and are therefore are more likely to thrive with a delivery model that recognises that. This permissiveness has perhaps been most evident in his backing for the devolution of health and social care to Greater Manchester. Mr Stevens was also one of the first from the health world to state publicly that social care should have the first call on any additional government funding.
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