The speech that never was: Kenneth Gibson MSP on 'radical' reform of local government and health boards
Fellow delegates, this resolution is about delivering a single, joined up coherent framework for improved delivery of services and better outcomes for people.
One that I believe will impact positively on affordability and sustainability to ensure the provision of integrated services.
Delivering preventative spending leading to better outcomes for the people of Scotland has long been a clear goal of our SNP Government.
At a time of great financial challenge - following year-on-year cuts to Scotland’s Budget by successive UK Labour, coalition and Tory governments - the SNP Government had the courage to look to the future and invest £500m in preventative spending over these last five years, signalling a serious commitment to the issue and the reform of public services distributed through three change funds: Early Years, Reshaping Care for Older People, and Reducing Reoffending.
These funds helped refocus spending within our public service and each has had considerable success. Numerous useful and innovative projects leading to life-changing improvements in people’s lives were spawned.
However, these have not yet brought about transformational or system change, as umpteen evidence sessions to the Scottish Parliament’s Finance Committee from a huge range of stakeholders, including Scottish ministers, will attest.
What has been repeatedly emphasised is that ‘silo’ mentalities are still prevalent in too many areas, with budget design in isolation and single outcomes approached from different directions across different performance frameworks with inconsistencies across the country.
The SNP Government is providing £250 million of investment in the year from April to support the integration of health and social care, ushering in what is hoped will be a fundamental realignment of the way the NHS and local government delivers care.
In Ayrshire, three integration joint boards which liaise between NHS Ayrshire & Arran and each of the three Ayrshire councils have already been established to discuss, debate and deliberate on just exactly how this will be delivered. This is not an easy task.
A frail and elderly local authority tenant requests a handrail. There is a waiting list. If she falls and is injured, the NHS will pick up the tab, yet earlier action by the council could have prevented it.
Shared objectives through integration boards represent progress. Having a person-centred focus with one responsible public body would be even more effective and help to tackle persistent problems of social and economic inequality and inter-generational cycles of deprivation and disadvantage.
In 1995 the Tories reduced nine regional, three island and 53 district councils to 32 single tier authorities. The Tories were keen not to set up councils to deliver the most effective services. Their goal was to establish what they hoped would be Tory enclaves, for example in East Renfrewshire and South Ayrshire.
Whether one considers the delivery of services, economic development or improved health, the current model of 14 health boards and 32 local authorities is neither sustainable nor desirable.
Curiously, the current structure has many local authorities that are not quite big enough to drive optimal economic development, whilst at the same time being seemingly remote from the citizen.
So how do we square this circle? Firstly, by taking health under re-invigorated local authority control whilst merging – where appropriate – local authorities.
As this resolution is about committing the next SNP government to exploring these matters, it is not for me to detail exactly where and how that should happen.
As a suggestion, in Fife, the council and health board would merge on their existing co-terminus boundaries, bringing health under democratic local control.
In Ayrshire, the three councils could merge, bringing co-terminus NHS Ayrshire & Arran’s £669 million budget under the control - not of three existing councils and NHS board with their chief executives and teams of directors - but one authority, streamlining management and releasing resources to deliver enhanced front-line services with clearer objectives and greater efficiently, delivering, I believe, better outcomes for the people we represent.
These larger local authorities could focus on economic development, connectivity, social work and, working closely with the colleges, education.
What of the citizen in all this? We need to allow localism to work in new and innovative ways, whilst helping to shift attitudes. Localities are important. I live in Kilbirnie and when I ask people where they are from they say ‘Kilbirnie’ or ‘Ayrshire’, not the artificial construct that is North Ayrshire, which few identify with.
So let’s look to devolve decision-making to the level most commensurate with involving communities. Local planning matters, potholes, street cleaning, libraries, parks, museums, lighting and public toilets could all be managed effectively at ward level in my experience, giving councillors and their constituents a greater local say, making collaboration with third sector partners easier.
I believe arguments can be made for housing to be run more locally too.
The SNP Government has shown itself to be bold and radical in government, working not for vested interests or the status quo. This resolution is in that radical tradition. I ask you delegates, to give it your wholehearted support.
SNP MSP Kenneth Gibson is convener of the Scottish Parliament's Finance Committee. This speech was set to be delivered at SNP conference as part of a resolution on reform of the public sector, however the resolution failed to be discussed.