Chapter 6

Local v national

The nature of the NHS as a national organisation and councils as local organisations
was raised by another finance officer.

They wrote: “I think the key issue is in the titles of the organisations. A National Health Service designed around a national approach and national guidance and under the direction of the secretary of state working alongside a local authority which is structured to align to local priorities, political initiatives and local circumstances.

“The national v local agenda is very difficult to tackle.”

Another finance officer said they were worried about the “cohesiveness of partners within the context of local geography”.

For another, “the ask from government is too big and will not be flexible enough to provide real care and support to the people that need to use health and social care”.

One public health officer identified the biggest stumbling block as “historical working difficulties”. Expanding on this, they said the problem was “principally the difference between senior level agreement on strategic approach (all agree on the same principles) and lower-level management implementation of reality (working practices, and – most importantly – trust needs a great deal of development)”.

Issues around data came up. One officer working in children’s social care wrote: “Different databases are used in health and social care and rightfully so; to integrate
them will be worrying. A person’s health care history is quite personal and they do
not want to leave it there for more persons to access.”

Similarly, an officer working in ICT warned that “data protection will prove challenging in relation to public trust”.