Re: New era for health services will focus on systems and creativity—an essay by Nick Black
We agree with Nick Black (BMJ 31aug18) that health systems are still beset with problems, despite the achievements of the era of assessment and accountability.
Black suggests that central authorities will have to relinquish some control to enable local creativity to flourish and that greatest challenge might be public concerns about changes to cherished ways of doing things.
In this context it is interesting to note that another large part of the public sector, namely local government, has been able to deliver significant changes. Total government support for council services has fallen by a substantial amount since financial austerity began in 2007 and yet measures of public satisfaction with council services have fallen less than 10% in the last 5 years (1). Diversity is built into local government by local democratic control, and public concerns about change can be voiced through petitions, public questions and through local media reporting.
Local government can bring NHS stakeholders together in a way in which NHS organisations have, perhaps, found more challenging in the past. For example, in central London, as Public Health, we brought together acute hospital teams, community health care commissioners and providers, social workers, academics and the third sector to form a Community of Practice (COP), map the local pathways across all the sectors and facilitate a conversation about most effective ways of working. In this case, the COP's aim is to reduce the numbers of residents’ falls.
It is early days, however, the feedback has been outstanding. We believe this provides an excellent example of how local government can facilitate and champion integrated working whilst building on skills and assets in situ. Maybe this is an important source of the social entrepreneurship that Black seeks.
Dr Mike Robinson
Public Health Consultant & General Practitioner
Dr Kate Mtandabari
Professional Development Consultant & MD
Rapid Response:
Re: New era for health services will focus on systems and creativity—an essay by Nick Black
We agree with Nick Black (BMJ 31aug18) that health systems are still beset with problems, despite the achievements of the era of assessment and accountability.
Black suggests that central authorities will have to relinquish some control to enable local creativity to flourish and that greatest challenge might be public concerns about changes to cherished ways of doing things.
In this context it is interesting to note that another large part of the public sector, namely local government, has been able to deliver significant changes. Total government support for council services has fallen by a substantial amount since financial austerity began in 2007 and yet measures of public satisfaction with council services have fallen less than 10% in the last 5 years (1). Diversity is built into local government by local democratic control, and public concerns about change can be voiced through petitions, public questions and through local media reporting.
Local government can bring NHS stakeholders together in a way in which NHS organisations have, perhaps, found more challenging in the past. For example, in central London, as Public Health, we brought together acute hospital teams, community health care commissioners and providers, social workers, academics and the third sector to form a Community of Practice (COP), map the local pathways across all the sectors and facilitate a conversation about most effective ways of working. In this case, the COP's aim is to reduce the numbers of residents’ falls.
It is early days, however, the feedback has been outstanding. We believe this provides an excellent example of how local government can facilitate and champion integrated working whilst building on skills and assets in situ. Maybe this is an important source of the social entrepreneurship that Black seeks.
Dr Mike Robinson
Public Health Consultant & General Practitioner
Dr Kate Mtandabari
Professional Development Consultant & MD
(1) LGA Resident Satisfaction Polling - June 2018. https://www.local.gov.uk/lga-resident-satisfaction-polling-june-2018 [accessed 10 September 2018]
Competing interests: No competing interests