23 September 2022 – NED webinar – Local government and collaborative working

This week’s session opened in conversation with GGI principal consultant Aidan Rave, who offered insights gained during an extensive pre-GGI career as a local politician and chief executive of local authorities and chief executive of a national charity.

Aidan said: “In local government there’s a sense of slight ennui about yet another reorganisation of the NHS. There is a sense of threat that it’s the NHS tanks manoeuvring onto the local government lawn. But also, where there are well developed and integrated partnerships there’s also a sense of opportunity and we’re already seeing this move at pace in some areas. The NHS needs to take the sense of threat seriously and decide what to do to address it.

“I come from a local government background, and I have the utmost respect for local authorities but that doesn’t mean they’re infallible. Local government should take a long hard look at itself and its history of developing partnerships. Neither side has a particular moral advantage in this context. Back in the mid-90s the Major government had swallowed the pill on partnership working through things like the Urban Regeneration Fund. But we never really got to the root of what collaborative systems working is all about and I still think we still have a lot more work to do in that space.

“The 'secret sauce' of integrated care sits in that ability to really focus on developing effective partnerships – by taking them more seriously than we have before and also by recognising what we’ve done wrong before. Each partner should go through a sort of truth and reconciliation process of recognising that we haven’t done it all right and we need to do things differently in the future.

“This is the difficult end of the managerial spectrum: creating effective working relationships across organisational boundaries with different governance structures, different value sets, different cultures, different motivations and outcomes. It was never going to be easy. It’s the quintessential complex challenge – lots of moving parts, none of which is predictable, all of which is subject to external pressure through political, economic and social challenges. One of the problems that was baked in from the outset was that the City Challenge scheme was a challenge fund where you bid for money. It made it about money. But it missed the ability for us to create structural settlements that enabled support to people throughout their lives, whether that be economic, or health, or community safety or wellbeing. We didn’t explore where the problems were coming from in the first place and asking what we could do together to improve outcomes.

“So it’s probably no surprise that we’re still in that slightly competitive space. We’ve probably all sat around partnership tables where it feels a bit like a game of poker, where we have a few cards but what cards have our neighbours got and how do we potentially get one over on them?

“We exist in one of the most over-centralised systems of government in the developed world. We are where we are to some extent but what changed with Covid was a tacit acknowledgement from central govt that they either couldn’t do it themselves or didn’t want to. There was no option but to work together so many of the barriers were swept away. I thought at the time if we could just bottle some of that pragmatism and take it into ‘peace time’, our jobs would be so much easier. But if we’ve done it once we can do it again.

“I think we’ve lapsed into some bad habits since Covid. Health inequalities were so explicit during the Covid crisis. It’s one of the lessons we could have taken forward much more coherently than we have done. We don’t take partnership working seriously enough. We don’t invest enough managerial time into it. We don’t invest enough governance championing into it. We don’t invest enough academic research into it. And we don’t invest enough political rhetoric into underpinning it. I think we see it as an ancillary to the job; we don’t see it as central to the job. Until we address that we will always lapse into those bad habits.

“I think the task for ICSs is crystal clear. The most fundamental challenge that they face in the pursuit of trying to be successful is to build effective partnerships in their patch and put the requisite time and effort into doing that. Even when that’s achieved, all you’ve really got is a blueprint that needs to be continually developed because of the constant evolution of political, economic and social pressures.”

Also overheard:

“I think the issue about the lack of need to squabble about money during Covid was hugely important in driving partnership. NHS sees itself as under resourced. Local government sees the NHS as having its mouth filled with gold whilst their budgets are savaged! This doesn't provide a great environment for partnership working to be fostered in.”

“Social care needs to be sorted out but both NHS and LAs have let down the community. Money is a powerful driver and LAs are vulnerable, which is why social care and public health should have moved to the NHS.”

“LA CEOs frequently remind me that if they overspend, they go to prison! in the NHS it’s not quite the same. On the other hand the politics of health mean that no government would dare do to NHS services what LAs have had to do with all of their services in terms of closure and reduction.”

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These meetings are by invitation and are open to all NHS non-executives directors, chairs and associate non-executive directors of NHS providers. Others may attend by special invitation.

If you have any comments, questions or suggestions about these webinars, please contact: events@good-governance.org.uk