Opportunity knocks with latest 'last chance'

In his latest article for MJ, GGI partner Aidan Rave argues that local government must be at the heart of the 10-year Health Plan if it is to work and there is much potential for genuine co-design and integration

OK, let's get the negatives out of the way first. Imagine your house is on fire and a neighbour turns up with a bucket of water. You can't fault the principle that water is a proven means of subduing fire, nor the helpful intent to try and help. Regardless, it's not going to put the fire out, is it? So it is with the 10-year Health Plan for England, which has fine intentions and broadly says the right things but is laughably light on the detail of implementation or how the shift from acute to community care is going to be achieved without any additional resources. There are other issues too.

One, this 10-year plan follows on the heels of the ‘long-term plan' launched to much acclaim in January 2019. Much like the well-intentioned prime minister of the day, Theresa May, it really didn't pass the test of time. Why would there be any confidence that it will be better this time, in a world of flat growth, massive instability and surging demands on other budgets, not lease defence?

Two, history teaches us that plans can have unintended consequences. Stalin made great strides with his first round of plans in terms of industrialisation and modernisation, but at the cost of massive contraction of agricultural capacity that led to famine and millions of deaths. Even in democracies, every action has an equal and opposite reaction. The focus on prevention is absolutely right, but it's naïve to think it can be implemented without short-term pain elsewhere.

Three, while the intentions of the plan are right, they are still framed through the Bob the Builder lens—'We can fix 'it'—which we can, but only with the emphasis on the 'we', which requires much stronger leadership and championing of the role of personal responsibility than currently seems to be within the political zeitgeist.

Over the last 15 years, local government has time and time again proved itself to be the ‘grown-up in the room' when it comes to not only adapting to challenging operating environments but also to consistently delivering within that context. While the sector faces its own challenges, there is no getting away from the fact that for this 10-year plan to work, local government must be at the heart of it.

A cynic might well read this latest incarnation of the NHS's last chance saloon with a reasonable degree of ennui. We've certainly heard it all before and given the parlous state of our national finances, we may well ask ourselves, what exactly is different this time? The language is bold; ‘reform or die' is a pretty stark phrase to be found in an official government document – certainly not one that is common to other challenges like policing or even social care (even though everyone knows this is pretty much the case).

So, the 10-year plan is not a panacea and contains little in the way of genuinely new thinking, but does that make it a bad plan?

No, because it was always going to be much more about actions rather than words. As Lord Darzi reflected in his defenestration of the NHS in September last year when he observed that the NHS is perennially better at planning than it is at delivery – and it's always ultimately about delivery.

Importantly, that's the big opportunity for local government.

Over the last 15 years, local government has time and time again proved itself to be the ‘grown-up in the room' when it comes to not only adapting to challenging operating environments but also to consistently delivering within that context. While the sector faces its own challenges, there is no getting away from the fact that for this 10-year plan to work, local government must be at the heart of it.

This won't be easy, of course. The still nascent Integrated Care Boards (ICBs) – and systems – have exposed the difficulties of working together, bound up in cultural estrangement, suspicion and even a mystifying but potent combination of professional arrogance, ignorance and jealousy.

This is not sustainable; certainly not for the NHS and arguably not for local government, which will no doubt bear the brunt of an inefficient but still politically sensitive NHS soaking up ever more meagre national resources.

The potential upsides for genuine co-design and integration are many. The NHS, along with local government and the voluntary and community sectors, can be a significant force for good at neighbourhood level. They can bring to bear the organising resources of the state to analyse, act and quickly learn from attempts to achieve a left shift in a way that no other arm of the state can. They can also nudge and shape behaviours at a local level in a way that national government seems unable or unwilling to do. They will not do this with a continuation of the poker games seen around ICB tables for the last three years.

The 10-year plan might not be in itself transformative, but the principles that it signals and the urgency in which those principles are framed are certainly an opportunity to be grasped.