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Genuine engagement on health reforms must start now

Cllr Jonathan McShane calls for more transparency and engagement around the North East London STP, warns against Hackney's NHS funding being taken to bail out other areas, and lays out four tests it must pass to be endorsed by the Council.

Cllr Jonathan McShane, Cabinet Member for Health, Social Care and Devolution
There’s a lot of talk at the moment about changes to health care, both in Hackney and across the country, and with that comes a lot of uncertainty.

As Hackney Council’s Cabinet Member for Health, Social Care and Devolution, and Chair of the borough’s Health and Wellbeing Board, I regularly hear confusion, suspicion and anxiety expressed by residents, patients and health professionals.

Much of the concern relates to the North East London Sustainability and Transformation Plan (NEL STP), which covers City and Hackney along with another six boroughs. STPs are proposals overseen by NHS England where the health organisations in a region have to agree how they can provide more joined-up services with less money. There are 44 across the country, and they are expected to finalise their plans by next year.

Many of the areas the STP emphasises are things which most people would agree with: a focus on prevention, early intervention, helping people live more healthily, and increasing the understanding of and support for mental health. Equally, few would disagree that hospitals, GPs, councils and the many other organisations involved in care need to work more closely together and treat the whole person rather than individual conditions.

An integrated health and social care system based around prevention, promoting independence and person-centred care should also be less expensive. With an aging population and a Government reducing funding for health and social care, we need to make the most of every pound we get.

However, the confusion around our STP and the concern being expressed is understandable and justified.

There has been a lack of transparency and engagement with residents and the democratically elected local authorities which represent them. Councils deliver the public health and adult social care services fundamental to helping prevent ill-health and supporting independence. They are also the organisations which can embed health and wellbeing considerations into areas such as housing, transport, parks, leisure and job opportunities - the ‘wider determinants’ of health. Given all this our lack of real involvement to date is worrying.

I wrote to the Health Secretary Jeremy Hunt in July expressing these concerns. Since then, we have been assured we will be given greater input, and public consultations on the STP are expected to start next month. The latest draft was submitted to NHS England on 21st October. Once this has been published local people need to be given enough time to give meaningful feedback.

Hackney Council, Homerton Hospital, City and Hackney CCG and the many other health organisations in the borough have a good track record of working together. We are one of the few areas in London delivering on performance targets and able to invest in new services. However, we are a rapidly changing borough and still face significant health inequalities.

As far as we’re concerned, local organisations working with their residents, patients and voluntary sector are best placed to deliver an effective and sustainable person-centred system, alongside the wider NHS.

This is why last year we successfully applied to be a health devolution pilot. Our shared vision for the borough covers the whole range of wellbeing - from public health initiatives for children, timely access to GPs and community pharmacists, and top quality hospital treatment. It also covers improving mental health services and supporting people to remain independent in their own homes for as long as possible. Our local residents and patients will play a key role in shaping our proposals.

Our devolution pilot currently forms part of the STP, which is encouraging to see but we need to make sure a top down plan doesn’t get in the way of us doing what is right for Hackney. Hopefully we will continue to be able to progress our local work as planned, without interference from a new tier of regional management.

Our local NHS performs well and has managed its finances better than most other areas. We are clear that we won’t accept any proposal that takes vital funds away from Hackney to plug gaps in other parts of North East London. Robbing Peter to pay Paul is not a long term plan for our NHS.

Hackney Council has no formal sign-off role in relation to the STP but we will only endorse a plan that meets the following key tests:

* There has been a genuine consultation with local people
* Council recommendations on social care, prevention and the wider determinants of health have been acted on
* Our ambitions for integration of health and social care as part of Hackney’s  devolution pilot are supported
* There are no proposals to take funding from Hackney’s NHS to bail out other parts of North East London 
Cllr Jonathan McShane, Cabinet Member for Health, Social Care and Devolution