Let’s remake the state

By Donna Hall | 02 June 2020
  • Donna Hall

Dominic Cummings explains in his blogs that he models his political strategy on his hero, the ultra-conservative centralist Otto Von Bismarck, Prime Minister of Germany who was responsible for its successful unification.

Herr Bismarck was struggling to get the small disparate German states to come together to create the German Empire until he had an idea. Let’s pick up on the mood of the people and create a common enemy to bind us all together with common purpose. The enemy was France. The thinking behind Taking Back Control, the NHS slogan on the side of a bus and the Turkish immigration poster had its origins in the Franco-Prussian war of 1871. Both strategies worked.

But is centralisation always the best approach to maintaining national unity and delivering results on the ground in communities? Does it always deliver the best economic, social or health and well-being outcomes for citizens?

Modern day Germany, under Angela Merkel, has adopted a decentralised model to tackle the coronavirus pandemic. Each region has been tasked with developing a bespoke test, track and trace system working with all the local resources in the area to swiftly identify people who have tested positive for COVID-19 including those who are asymptomatic to all of their potential sources of infection.

This localised leadership and lockdown approach seems to have happened everywhere except in England.

Separate national centralised initiatives have recently been layered on top of each other in a disjointed and somewhat chaotic way. A national call handling system, an untested app piloted on the Isle of Wight, Public Health England overwhelmed nationally mid-march (so consequently contact tracing was abandoned). It has been shambolic. Centralism isn’t always strategic or pragmatic or cheaper; it can also be massively expensive and ineffective when national systems don’t connect properly with local tried and tested systems.

As I write this the health secretary has announced that contact tracing will start tomorrow. I’ve just spoken to a director of public health and a GP who both say there is no protocol in place and no funding as yet.

We are already three months behind the rest of Europe on this; Greece and Eastern Europe, among the world’s poorest countries, are more organised than us and have more boots on the ground to attack the virus aggressively in the way recommended by the World Health Organisation. We ignored its guidance because of our obsession with tech, private sector solutions and centralisation.

I chair a fantastic NHS Trust. All our deep-rooted financial issues were resolved at the start of the pandemic and our performance metrics kicked into the long grass at the stroke of a pen. But what about local government, the services who protect the most vulnerable? What about community groups on the frontline in the response to supporting vulnerable and shielded residents? All of these unresolved issues and more people needing acute care as a result puts pressure on our NHS Trust. It’s the system stupid! It’s the system that needs to wrap itself around communities.

I’m not sure the increasingly silo policy makers in Number 10 understand the reality of how people live on a day to day basis and of how ministerial silo decisions impact on local places. I agree with Dominic Cummings that there needs to be a change in this respect but to devolve more, not to centralise more.

Our NHS Trust has been saved by NHS funding decided by one Government department when adults and children’s social care in the council has been repeatedly starved of resources throughout austerity for more than 10 years. Testing and tracing has not been set up, yet we are three months into a pandemic, and councils are teetering on the edge of bankruptcy. We have gone way past the burning platform and are now standing on the last smouldering plank of the fondly-remembered structure.

A devolved approach would see local councils or strategic transformation partnerships with an integrated place-based budget to allocate to their unique priorities, depending on the specifics of the place. For example the recent outbreaks in Barrow, in Rochdale, in St Helens can be adequately resourced and staffed in a granular way based on local circumstances not national per capita allocations. Devon is very different to Knowsley.

Communities are not only fed up; they are very angry. Fear and unfairness are at the heart of the feeling in communities right now. This energy could be captured and channelled into a new state with councils and the NHS at its heart, based on our brilliant communities, where there is genuine passion and determination to make sense of the shambolic centralised mess. That energy could be transformed into practical local action with the people we serve.

Prof Donna Hall CBE is chair of the New Local Government Network

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