Room151 Opinion: The vast experiment in local government
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Simon Stevens, chief executive, NHS
Local government officers attending CIPFA’s annual conference may well have wondered if they were in the right place. CIPFA’s president, John Matheson, is from the NHS, the first speaker was Simon Stevens, chief of the NHS, and speakers followed on Scottish devolution and then health and housing. Where’s the local government?
Indeed, in the midst of austerity the speakers seemed to be making the case that local government finance officers should help them, as if all was well in town halls up and down the country.
Of course, that’s not the full story. CIPFA’s programme spoke volumes about the future of local government. And it is a complex one where siloed thinking and spending comes to an end as public services integrate, partner and pool budgets to gain the most out of shrinking resources.
Indeed when Simon Stevens delivered his presentation it was to stress that whatever troubles beset the NHS, a significant strategic route forward will be working more closely with other agencies. He cited the example of the Manchester Health Academy, a collaboration between Central Manchester University NHS Trust, Manchester City Council and the Manchester United Foundation.
He also talked at length about NHS and social care services working more closely as well as a belief in “placed based” approaches, a belief which saw Stevens declare himself an enthusiastic signatory to Devo Manc which sees £6bn of health and social care funding pooled together under the Greater Manchester Authority.
All these combinations, he said, should see outcomes add up to more than the sum of their parts. Or, as Stevens put it: “My enthusiasm stems from the possibility of putting one and one together and getting more than two.” And that, he told the hall, was the best way forward, even if politicians had agreed the NHS needs more cash.
A similar theme was never far away when John Swinney, MSP, and cabinet secretary for finance in the Scottish Government, commented on the lessons English authorities could draw from Scotland’s experience of devolution, and how a pubic sector finance profession could contribute.
He advised English councils to argue for a “cohesive” set of responsibilities so they could “undertake meaningful action at a local level” and stressed that his own guiding principle when considering services is whether they are “aligned” to focus on the same solutions.
Later Clare Tickell, CEO of Hanover Housing Association, underlined the need for closer working with other agencies. Indeed, Simon Stevens had earlier stressed how the NHS had to be part of the housing “equation”.
Combine all of that with a ubiquitous belief in “innovation” as a shared ambition and you have a future which sees the end of services being delivered by a single agency and in which budgets, functions, buildings and aims become shared and coordinated across agencies.
In some cases this may lead to big questions about the future of some stand-alone bodies, the involvement of the third sector and understanding the place of the private sector in service delivery.
Finance officers will need to embrace this complexity, learn its language and behaviours, and potentially begin building a new wing to the discipline of public sector finance so that cost sharing can be fully understood and mastered. New forms of disclosure may be required and governance structures will need to keep pace.
Intriguingly, CIPFA’s conference programme goes beyond austerity and towards embracing a new era of local government finance, accepting that the sector is now engaged in a vast experiment in which the rules of public service provision are being rewritten. Fast.
Image (cropped): Two Visual Thinkers
