Placing health at the centre of growth
Moving from sector to sector, it is increasingly clear that ‘place’ is becoming the main currency of change. This emerging consensus is refreshing in its local empowerment yet, for many, also quite daunting. Collectively, we are being asked to run locally before the legislation, funding and metrics nationally have learned to walk. As Dorset shows, though, the risks are worth it, explain Michael Wood of the NHS Confederation and Lorna Carver of Dorset Local Enterprise Partnership.
For such a heavily centralised nation, ‘place’ can be as daunting as it is empowering. Whether we are talking about the economy, far too dependent on services and the south east and for far too long, or the health service, where the reverberations from falling bed pans still echo around Whitehall, local leaders in England are seeking, and gaining, greater power and control. The challenge facing places like Dorset now is how to make the most of it.
The meeting ‘place’
The real power of ‘place’ is that it is the only point at which systems, strategies and society meet. And, for all of us locally, this matters.
In health terms, Dorset’s integrated care system (ICS) is considered one of the most advanced of England’s 44 new regional approaches to transforming the local provision of health and care. This emphasis on collaboration and local leadership is very much a welcome change of direction for a health service more used to ‘command and control’ and begins to address the cultural, and financial, imbalances that often exist between health and social care.
In parallel to this, the economic leaders in Dorset, like every other mayoral combined authority or local enterprise partnership (LEP) area in England, are reflecting on the necessary building blocks for the development of its local industrial strategy. This strategy will map out the long-term needs of Dorset’s economy and the partnerships and priorities necessary to fulfil its potential. Its focus on improving productivity will require new approaches, powers and forms of finance in order to stimulate greater economic and inclusive growth.
When looked at in isolation there is much these two strategies can achieve locally and much that would please the respective national ministries. However, the added value of ‘place’ enables us to go further together, turning challenge into opportunity.
Dorset’s challenges and its opportunity
If ‘place’ is about coming together, then the local links between health and wealth certainly ignite discussions between the leaders of Dorset’s NHS, local authorities, university, colleges, industry, Academic Health Science Networks (AHSNs) and LEP.
Dorset’s ageing population is a good example. Seen through the eyes of a health and social care system under severe financial strain, having 28 per cent of the current population aged 65 and over, against a UK average of 18 per cent, represents an existential challenge to local transformation planning. To those seeking to develop a world-class R&D and industrial base in associated innovation strengths, however, this demographic – which according to the WHO is similar to where the rest of the world will be in 2050 - represents a significant opportunity.
It is also worth reflecting on the main economic challenge facing regions in England: low productivity. Dorset’s region, the south west, has some of the worst GVA measures in the country. Contributing to this is the lowest proportion of working age population of any region. To translate this in to everyday business, local people in Dorset are struggling to get into employment, with both low and high skills roles staying unfilled, limiting the ability of businesses (and the local tax intake) to grow and increasing local demand for public services. Linked to this, almost 8 per cent of the population in Dorset are living in the most deprived areas of England and life expectancy for men across the area varies by more than 11 years. Widening local health inequalities mean widening local wealth inequalities and vice versa.
If it is this shared economic and social approach to place-making that government is seeking to foster, then Dorset is in a good place to take advantage, with local partners intent on sharing both the risks and the rewards of joint action.
A joined-up approach
The co-terminosity of health, local authority and LEP footprints in Dorset helps, of course, but it is the relationships locally that really matter. Let’s look at some examples. The ICS in Dorset is the first in the country to align all regional partners in its research network through Research Active Dorset (RAD), which will play a critical role in enabling the area’s health R&D capabilities. Dorset County Council is looking at maximising the use of and financing for its public assets, including key-worker housing and meeting future demand. Bournemouth University continues to lead health-related collaborations with the range of partners, many of which are actively funded through the LEP. All clear alignments between our ICS and the Local Industrial Strategy and, collectively, an approach to ‘health and wealth’ that will help make Dorset an ideal place to live, work, study and invest.
We have already seen clues in how the government will adapt its funding programmes to further drive place-based work and health features strongly in Dorset’s plans.
The national Strength in Places Fund was launched recently to build on local research and innovation strengths and to tackle local productivity challenges. To be successful requires the involvement of local collaborations, rather than individual institutions, and the local economic leaders (whether LEP, Combined Authority or Metro Mayor). Dorset will hear back on its submission shortly but there will be significantly more money available in the coming years.
The coming months will also see the government finally consult on the replacement to European Structural Funds. The UK Shared Prosperity Fund will be one of the flagship post-Brexit funding programmes and will, as the name suggests, have a broad collaborative focus on the economic and social issues at the heart of prosperity. This funding will be critical in helping Dorset stimulate economic and inclusive growth and in realising both the ICS and Local Industrial Strategy.
Competing for attention
The ‘place’ agenda in England is naturally competitive. Money is finite, workers and businesses can come and go, investment can fluctuate, students can choose. What Dorset understands is that, together, you have a much better chance of addressing the local challenges we face than we do alone.