It’s all about that place – part 2

It’s all about that place, part 2 – reflections from the 2022 Local Government Association conference.

At the beginning of February our co-founder and managing partner Claire Kennedy responded to the recently published White Paper, celebrating the importance of ‘place’ in its vision. The legal framework described in the White Paper has now taken its first step, with Integrated Care Systems (ICSs) formally taking responsibility for the delivery of local health and care systems. This milestone coincides with the end of the Local Government Association (LGA) conference, a three-day event where the challenges and opportunities of working at place was high on the agenda.

To open the conference Michael Gove, then Secretary of State for Levelling Up, Housing and Communities, set out his vision. And while we would be wise to remember this was a tailored speech to a specific ‘locally minded’ audience, his key message was clear: working in and providing power to local places is the only way we will tackle the challenges that people, communities, and public services face.

Lisa Nandy, Shadow Secretary of State for Levelling Up, Housing and Communities and Liberal Democrat leader Ed Davey both spoke on subsequent days, and while they were (unsurprisingly) critical of Michael’s plans, it was impossible to ignore that the vision of putting place at the heart of change was the driving feature for them all.

With a cross party vision of place and new legal frameworks for the ICSs to work collaboratively, surely achieving the opportunities of place are at our fingertips? Not quite. Victor Adebowale, Chair of the NHS Confederation, reminded listeners that ICSs were not an NHS entity but a partnership. Yet in some cases local authority leaders were quick to raise that this was not their experience and that this felt much like a top-down NHS process that was all too familiar. Solving challenges and rebuilding relationships in these places will be key to unlocking success at place. While both the representatives from NHS England and the Department of Health and Social Care were quick to express their commitment to this, the challenge will be in the doing.

Additionally, ICSs are not (at least in most cases) places. The issues of local accountability at place highlighted in Claire’s article in February remain, and my discussions with representatives of local government last week highlighted the challenge of creating parity at place.

As Victor also highlighted, ‘culture beats structure every time.’ It was clear throughout conference that long term transformation at place will require a culture change both within our systems and statutory organisations and in how they work with the wider voluntary and community sector, and communities themselves. The connection and collaboration with communities was a theme that appeared far more frequently than in any previous LGA conference that I have attended, central to the political party speeches, and echoed throughout all levels of conference. Baroness Lola Young’s talk on the importance of culture to support wellbeing and prosperity at place, also articulated the power of this being led by local communities. Community power was also central to the interventions supporting equality, diversity and inclusion in projects across York, Warwickshire and Hackney, and in the application of behavioural sciences to co-produce change with communities in the Wirral.

What felt much more familiar were the challenges facing our local public services: money, workforce, and the capacity of local systems to tackle global challenges (cost of living, climate change, global conflict, political uncertainty, the ongoing march of technology). These challenges are occurring alongside an extensive set of reforms in integrated care, new social care payment reforms and the introduction of CQC oversight. While familiar, these challenges and opportunities are not the same. As Ben Page, CEO of Ipsos explained through his data-driven outline of the current world,

“History does not repeat itself, it rhymes. Even if we cannot predict the future, long term thinking can help prepare for it”.

It is clear that these challenges cannot be solved by individual partners, and the true success of both ICSs and the place-based partnerships within them will be their ability to create environments where long-term thinking, planning and action can be taken forward collaboratively.

My time at the conference re-enforced a key point that I already knew – there is still lots to do if we are going to achieve our visions of improving health and wellbeing outcomes for our local communities and eradicate inequalities from our society. But it also confirmed another key point – that if local government works in partnership with its local NHS colleagues, VCSE sector and communities themselves to define innovative person-centred solutions to the challenges, then we can make a difference. The launch of the ICSs provides a framework for doing this, but the launch must be seen as a next step in an important journey, not an end point.