Are council leaders right to be worried about a ‘power grab’ by the NHS?

The publication of a draft constitution for Integrated Care Boards has provoked concern amongst council leaders that local authorities will be excluded from decision-making

20th January 2022 about a 4 minute read
"A major reorganisation in which councils become the junior partners to (relatively speaking) large and powerful NHS trusts could see their role diminish even further, leaving social care and public health in an even weaker state than they are currently." Greg Allen, CEO, FCC

Northumbria NHS Trust has announced that it is to start providing home care services. This move into social care is a major step for an NHS trust, particularly one whose principal focus is acute care – and may be a sign of things to come.

There is a lot to be said for the move. The separation (or lack of integration, to be exact) of health and social care has been a problem for a long time and some patients have found themselves languishing in hospital because there is no home care provision for them. The decision by the trust is in line with the plans laid out in the government’s Health and Social Care Bill to integrate the two sectors and will enable it to smooth patient transition from hospital to home. As chief executive James Mackey said: “Having effective social care services is vital to the entire health system, because to allow the region’s hospitals to cope with the demand from new patients coming in, we need to be able to move on those patients who no longer need hospital care in order to free up beds.”

So, should we welcome the move – or could it be the first sign of a troubling over-reach by an NHS trust into matters that are normally the preserve of local authorities?

Will the NHS claw back public health powers?

To answer that, we should take heed of another news story this week, about council leaders expressing their anger at what they see as a potential power grab by the NHS. At a recent meeting of the city regions board of the Local Government Association (LGA), Graeme Miller, leader of Sunderland City Council, said that the NHS was planning to take powers away from local councils, describing it as an “attempt at political castration.”

What prompted such a furious response? The Health and Social Care Bill is currently navigating its way through parliament and will create 42 integrated care systems (ICSs) throughout England that will bring together GP surgeries, community and mental health trusts, hospitals and other primary care services, with local authorities and other care providers. They will be responsible for delivering health and social care in their region.

The ICSs will be run by integrated care boards (ICBs) made up of NHS trust representatives and others. The reason Miller and other local authority leaders are worried is that NHS England’s model constitution for the new integrated care boards (ICBs) explicitly excludes councillors and MPs. Although this exclusion isn’t specified in the Health and Care Bill going through parliament, the concern is that many ICBs will adopt the exclusion clause.

The fear expressed by Miller and others such as Danny Thorpe, leader of Greenwich Borough Council, is that local health services will claw back the public health powers councils have had since 2013 and seize more funding for acute services.

Resources could pour into hospitals at the expense of social care

Are councillors right to be concerned? It’s certainly the case that integrated care boards will be large organisations responsible for covering huge geographical areas. For example, as Miller pointed out, it’s difficult to see how an integrated care system (like North East and North Cumbria which runs from the Scottish border down to the south of Yorkshire) will be able to deliver services tailored to local needs. Miller’s fear is that the acute trusts will use the boards as a way of gaining “power and money”. Resources will be poured into hospitals at the expense of primary care services, public health and social care – a sector that is already underfunded and suffering major staffing shortages.

Councillor John Merry, deputy city mayor at Salford City Council, has pointed out that Greater Manchester already has a full integrated budget with the NHS and that the new ICS structure will be a step backward, giving more power to the two large acute trusts in Manchester.

NHS England has responded to concerns by describing local government leaders as “essential partners” in the ICSs. But we shouldn’t dismiss the fears of local councils so readily. Local authorities have already lost many of their powers over the years, and are operating on severely reduced budgets. A major reorganisation in which councils become the junior partners to (relatively speaking) large and powerful NHS trusts could see their role diminish even further, leaving social care and public health in an even weaker state than they are currently.

From the perspective of people receiving care – both now and in the future – it would be a shame if a government reform designed to strengthen the social care sector ended up achieving exactly the opposite.