Richard Humphries, Assistant Director (Policy) at the King’s Fund, wonders what local government’s relationship with the NHS will be like at 95 years old.
If a week is a long time in politics, as the late Harold Wilson used to say, then 30 years is an eternity. Local government’s relationship with the NHS will be 95 years old in 2043 – by then we will know whether the 2012 Health and Social Care Act really was a game-changing shift in the relationship between these two great public service silos. There is all to play for. Many aspects of the changes, if successful, will be so embedded in what Councils do that we will simply take them for granted – or they will have long disappeared. Health and Wellbeing Boards for example will either be the ‘go-to’ place for serious local decisions about health and care – or added to the roll-call of partnership initiatives that promised more than they delivered. 30 years will be long enough for councils to demonstrate how their public health role has made a real difference to the health of local people – though as ever much will depend on the political will of governments to embrace national policies in contentious areas like alcohol pricing. And with the frail older population and people with dementia set to at least double by 2043, the fault line between universal health care and means tested, rationed social care will be tested to its limits. The current fragmentation of commissioning across the myriad number of NHS bodies and Councils is not sustainable and current aversion to more structural change may weaken as the drumbeat for integrated care grows louder. But there’s a big “but” – our pubic policy tradition is to muddle through rather than embrace difficult, radical change. So “plus ca change plus c’est la meme chose” may be a more realistic scenario for 2043.