Councils have been warned they may need to test the legalities of Integrated Care Board (ICBs) cuts as restructuring plans leave gaps for them to fill.
A National Audit Office (NAO) report revealed ‘early signs' councils were being left with ‘gaps to fill' as ICBs are tasked with cutting costs by 43%, delivering annual savings of £908m and refocusing on strategic commissioning.
ICBs are planning workforce reductions of around a third (8,000) and many have merged or formed clusters to cover larger populations and drive out savings, with the total number dropping from 42 to just 25 by September this year.
The NAO report has been met with a chorus of calls from the local government sector to ensure the process does not lead to cost shunting.
Chair of the Local Government Association's health and wellbeing committee Cllr Wendy Taylor said: ‘There must be greater focus on evidence that changes in eligibility decisions and practice may be shifting costs from the NHS to councils. Any changes to CHC [continuing healthcare] policy or practice must not result in unfunded cost-shunting to councils.'
Chair of the Association of Directors of Children's Services' health, care and commissioning policy network Dheeraj Chibber said the negative impacts of ICB restructuring were already being felt by councils.
He said: ‘The pace of ICB restructuring coupled with the 50% savings imperative is having a real impact on partnership working and on children's lives.
‘Local authorities are seeing funding pulled from support packages that had already been agreed and experienced colleagues in health leaving, meaning key relationships at a local level are strained as resource and experience is stretched across ever larger areas.'
Despite the challenges, director of public health at Liverpool City Council, Matt Ashton, said relationships on the ground remained strong.
He continued: ‘We've got really good people that we work with. It's not the people; it's the organisations and the structures that get in the way. That is the challenge when any organisation restructures or refocuses – it just looks inwards for a bit before it picks up the pace and looks back outwards.'
Nonetheless, Ashton said the process had impacted councils' joint working with the ICB.
He added: ‘They are also incredibly focused on the financial recovery bit, on the HR issues, on restructuring and making sense of things, and that just means you get less response, and it also means the responses are quite immediate, it's not long-term planning. It's not particularly joint work.
‘The trouble is, on the local government side, we've been dealing with those kinds of challenges for over a decade, we're no different. But we still have to get stuff done and we try to do that in partnership. That's where we know the evidence base shows the biggest impact.
‘The issue is we are also the local leaders of place so, in a way, it is it is our role to fill, but we can't carry everybody's work when they're not doing it either.
‘We are local leaders of place, and rightly so, but you don't do this stuff by yourself. You do it with people and organisations, but it's not like we have spare capacity. We can't absorb other stuff as well.'
Despite the demands from within local government that Whitehall must avoid unfunded cost and responsibility shunting onto councils many recognise this remains a live risk and believe the sector should be prepared to up the ante.
Director of policy and research at think-tank Re:State Simon Kaye argued: ‘Instead of waiting for warm words of reassurance, councils may now need to identify where NHS functions are being withdrawn or reduced and insist on formal agreements about responsibilities and funding. Existing partnership and scrutiny arrangements can be used to challenge cost-shifting and make those consequences visible.
‘We should also be ambitious: councils should actively push for the transfer of the associated budgets, powers and capabilities, all as part of the boundary alignment and empowerment of strategic authorities that are already promised by the Government.'
Ashton suggested councils may even need to be prepared to challenge the legality of changes emerging from the ICB restructuring process.
He said: ‘I guess there is an issue about testing out the legalities of the way that organisations behave and whether they're not fulfilling their statutory responsibilities. I'm not saying that's what we're doing locally, but I guess that ultimately might be the challenge: Is there a legal challenge around whether people are doing what they should be doing and organisations are doing what they should be doing.'
Emphasising the importance of collaboration to finding lasting solutions, Ashton said robust challenge to potential buck passing may have to be called out.
He continued: ‘I'm a strong believer in setting the vision, setting the ambition and getting partners around the table to drive that activity. And it's through that consistent partnership work, with an ambition and clarity about what your priorities are, that you actually get stuff done. So, maybe there's an element about calling out partners when that's not happening.'
Ashton's comments came as health secretary Yvette Cooper told the House of Commons' Health and Social Care Committee that strategic authorities (SAs) could be empowered to enforce better collaboration.
Cooper said options included ‘legislative duties and responsibilities' and looking at funding flows and pooled budgets, adding that ‘giving the mayoral strategic authority oversight of the whole thing, so they can go in and bash heads together' was another consideration.
But while recognising that SAs ‘had a role', particularly at the political level, Ashton highlighted the challenge from unaligned boundaries for public service.
He added: ‘Our ICB is at a Cheshire Merseyside level, but, with our SAs, we've got a Liverpool city region one and an emerging Cheshire one. You operate across several different geographical footprints, which just makes it harder.'
