I read the news today, oh boy: what will we get, a re-organised or a re-positioned NHS?

There are some mornings that despite the wonder of a glorious sunrise, the singing of the birds and the smell of great coffee, there are still things that can immediately change your mood from happiness to despondency. Yesterday I opened my online newspapers and there, right on the first paper I looked at, was the news that Beano Boris was intent on reorganising the NHS. Apparently, Matt Hancock doesn’t feel he has enough power and is fed up with having ask to Sir Simon Stevens (NHS Chief Executive) to do things rather than simply ordering him to do so. Ah, poor lad. I can’t recall his predecessor, Jeremy Hunt, ever mentioning that he didn’t have enough power or control…

I’m not going to waste this blog posting on this issue, other than to say how many lives, careers, plans and ambitions will be negatively changed by any future NHS reorganisation. The NHS doesn’t need another reorganisation. Some changes to the prevailing legislation preventing integrated care services becoming legal entities would be the most helpful difference that might be made. Across the NHS, local effective integrated care partnerships and integrated care services have started to emerge. They have done so, not because anyone has ordered it, but because it the right thing to do, and people have put aside their differences and found ways to work together in new and exciting ways.

We have seen the consequences of the ‘command and control’ approach during the pandemic. Arguably, it was the right approach at the start of the pandemic, but continuing with it and even trying to strengthen the centralist way of working in the future is about as palatable as the notion of eating chlorinated chicken.

And I don’t want to waste this blog posting on that issue either, other than to say a big WELL DONE to Aldi, The Co-op, Sainsbury’s, M&S, Waitrose and Tesco who have all now said they will never sell chlorinated chicken or hormone-treated beef. Having been a long-time vegetarian, I would not have eaten them anyway. Image Adrian Dennis/PA.

Britain currently has strict food standards in place. However, as we leave the jurisdiction of the EU, the door is open to the UK accepting such products from the US as part of any post Brexit trade deal with Washington. Indeed, the Trump administration insist that free trade in all things agricultural is fundamental to any deal. The US National Chicken Council say that anything else would be unfair. Ah, poor them. What about the chickens?

Okay, what I really wanted to use this post for was to reflect on the Local Government Association’s recent publication: Re-Thinking Local. You can find the whole document here and I think it is worth a read. In some ways, it’s a setting out of the local government stall, ahead of what is expected to be the publication of the England DevolutionWhite Paper and more power and control being given to local councils. No date has been set for its publication. And despite Beano Boris saying last July ‘I do not believe that when the people of the United Kingdom voted to take back control, they did so in order for that control to be hoarded in Westminster. So, we are going to give greater powers to council leaders and communities’. That was of course, before he had a parliamentary majority of 80, and the arrival of Covid-19. Just saying.

Unlike central government, local councils have worked effectively with other local public services in meeting the challenges of the pandemic. They have proved that they are not there simply to deliver services or administer government grants, but to show effective leadership across the communities they serve. Local political leadership clearly works. It has brought together communities in a way not seen since the last World War. In maintaining many services during the pandemic, from refuge collection to caring for the most vulnerable in our communities, it has shattered the long-held (and well defended) myth that London, and Whitehall know best.

Sadly, the pandemic has also laid bare the many inequalities across local communities and populations. These are wide-ranging inequalities, and include inequalities of employment and financial security, educational achievement, health risks, quality and type of housing, and opportunities to prosper. The Office for National Statistics has highlighted the absolute link between the Covid-19 death rate and the deprived communities. In ‘building back better’, there is an opportunity for a rethink over so many areas of our everyday lives.

The Local Government Association document sets out what local councils can offer central government. It is not about power or control, but about partnerships, trust and knowing what works best at a local level. There cannot be a ‘one size fits all’ approach to dealing with deprivation. It’s about re-thinking what is possible, and re-thinking where resources should be made available. In the context of health and care, the approach should be about reshaping the health and wellbeing landscape, focusing upon prevention, and creating personal resilience and independence, rather than just treating illness. It is not about re-organising the NHS structures.

I’m of an age to remember many of the NHS reorganisations. Some had the desired outcomes; some were downright disastrous. All were hugely disruptive, expensive and most had several unintended consequences. The New Statesman carried an interesting article at the end of May this year, which captured well some of these consequences in the context of responding to the pandemic. Read it here. What it advocates, is a return to more local control of public health, integrated care services, and although sometimes choosing to use regional to mean local, provides a well-argued case for a re-positioned NHS rather than a re-organised one. For all our sakes, let’s hope that the Beano Boris health and social care taskforce have a New Statesman subscription.

N.B No chickens were chlorinated in the posting of this blog.