Public Health

Local Government finances and you

Local govt finances. I’m clearly off piste here, but given that money makes the world go round……

I went to do a session on the anatomy of heath cities a few weeks ago at a conference. Slides here. I just said what I normally say.

For me, what I heard in local government finance was definitely the most important input of the day – the show stopper.

We are way beyond local government folk whining about times being a bit tough. It’s an existential threat to the sector, and affects every single aspect of our places. In my experience, most of those that aren’t “in” it don’t see it.

Key points

Wider context – it’s everything

  • A decade of unprecedented disruption. Globally, every system – finance, political, business, government, etc. Our communities are sat within this. The idea we can control all around us is ridiculous. Think this through in different context
  • Brexit – coming out or staying in wasn’t the point. It was about disconnection from the way things are decided. Similarly, think this one through in all the decision making processes in a place

Funding in the sector

  • Deepest widest reductions the sector has ever seen
  • Initially thought to be a few years of “belt tightening”. But it’s become permanent
  • In some places more than 50% of the revenue budget has been removed in a single business cycle. Can your company keep the lights on in this context.
  • There is an existential threat to local government. It won’t be pretty for people and places
  • There WILL be more local govt failures. This isn’t about inept local govt management, it is about insufficiency of funding in local govt. Predicting when, where and how many impossible.

Beyond the sector narrowly defined, wider impact on places

  • this has affected every sector. Knock on consequences. Both the funding crisis per se and it’s knock on impact on other services worries leaders of police, NHS, our communities, schools and beyond.
  • This is not a local government problem. We are way beyond that. It is a problem for all those organisations, across many sectors that have a stake in our places

  • The impact on other sectors, notably the NHS, of social care cuts is well documented.

    The impact of local government finances on the astounding stuff undertaken every day in the voluntary sector is less well documented but no less important.

    Though perhaps not quite strictly related to local Government per se, there are many other examples, for example:

    • see the recent Resolution Foundation stuff on long term underfunding of schools. There are well documented examples of schools sending out letters to parents asking for support, not for the school trip but for books and pencils, you know stuff like that. Has anyone worked out the long term consequences of this.
    • See the recent Panorama on fall off in the % of crimes investigated by the police. Do we wonder why this is.

    Will we continue to see austerity

    • My own take is that is driven by the deep rooted belief that the problem is public sector debt (furthermore public services are seen as cost drain not an investment) rather than irresponsible money markets and lack of regulation.
    • Central Govt paralysed by Brexit, HMT not willing, or at best certainly doesn’t have bandwidth, to listen

    Developing a single narrative on local govt, and place, financing

    • Being complicit as we go over the edge is not going to happen. But the sector needs a more coherent narrative.
    • We don’t have a clear central narrative and message. Our arguments have oscillate between “people will die” to “it’ll all be ok”, we will transform our way out of it. We don’t have a single narrative.
    • Call for coherent sector wide set of arguments to 1) sustainable settlements, 2) immediate funding to avoid the cliff edge
    • Local Govt sector has not been well organised in setting this up. Mixed narratives across different parts of local govt, cuts across each other – county, district, core. We’ve not been joined up. Need to beware infighting between different forms of local govt and have single voice.
    • Compare what is happening to NHS, police, even prison services. NHS has had years of building a love affair with the pubic. People see LG as pen pushers, town hall fat cats, etc. Need to change that with different narrative
    • Public services are an investment not a cost drain.

    Signals are that

    • One year settlement will remain the norm
    • No change in macro financial environment
    • Short term sticking plaster solutions will be used. See last week for social care. £200m – isn’t even a band aid compared to what cut out. That £200m band aid won’t cover the wound, never mind heal it!
    • Line of thinking in Whitehall that as many LAs not yet deeply gone into reserves (financial and politically prudent etc) that Govt doesn’t need to take foot off gas

    Does it matter

    8 years of austerity has had a massive bearing on 1) our ability to get stuff done, 2) our disinvestment in things people call the determinants of health.

    This will set up demand downstream and outcomes, ie it’s well beyond being just about the money.

    It’s about what we can and can’t buy outcomes wise with the funding available.

    Don’t take my word for it. The NAO are quite vocal in this space.

    And this study highlights the differentials in the depths of the cuts across the country showing the uneven geography of local government austerity. Authors own blog on their piece here, Commentary here

    Concluding thoughts

    • Different is the only option
    • place based and assed based is only way to go. People as assets, not demands on services. Investment in outcomes for populations, not institutional protectionism.
    • Digital connectivity. Underplayed currently
    • Services that remain relevant to modern places. Should include debates around statutory services. We keep Victorian notions of service delivery. When did we think that delivering 100s of service lines, often disconnected from each other, from the town hall was the best way to progress. Different models, fundamentally different models needed.

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