will be needed to improve patients' health outcomes and so ensure that we have
a genuinely sustainable health and social care system.
3.3.4 Lack of political leadership at the local level
The fragmentation and failure of the two systems to integrate structurally
has resulted in a lack of joined-up leadership and people in charge at the
local level. This lack of oversight ultimately leads to a failure to act on health
inequalities as well resulting in a poor return on investment (48 per cent of
Clinical Commissioning Group spend is on 3 per cent of the population). By
contrast, strong collaborative leadership can open up opportunities to do things
that others, who haven't invested the time to build those relationships, wouldn't
have been able to make happen (for example, see the case study below).
Hexham General Hospital, Northumbria
Case Study: Northumberland County Council
Northumberland County Council and Northumbria healthcare have developed
a strong working relationship over a number of years. For example, they currently
share a director who covers public health, children's services and adult care for the
council, and also manages the community health service within Northumberland
Healthcare. As a result of these close working relationships there have always
been meetings between senior management teams to explore how the two
organisations can further work together in a mutually beneficial way.
For example, Northumberland Healthcare Trust had done a lot of work
to demonstrate they could secure significant efficiency savings if they could
terminate their Private Financial Initiative contract. This led to discussions
with Northumberland County Council around how they could raise the
necessary finance to achieve this. Steven Mason, the Lead Executive Director of
Northumberland County Council, suggested that the council could use prudential
borrowing powers to provide the funding.
Initially, Northumberland County Council embarked on a scoping exercise
to explore the feasibility of these proposals, including seeking joint counsel
opinion on whether the Trust and the Council had the legal powers to reach
such an agreement. There were a number of stages to getting the deal done, one
of which was obtaining approval from councillors to grant the loan. One of the
main concerns of members was the question of security and what would happen