Public Services Lab Blog

A healthy dose of localism

Laura Bunt - 27.08.2009

Nowadays we want flexible, adaptive services that can respond to local demands... but with the assurance that national standards will still apply; we want an NHS guided by fairness, but understand the value of local provision.

In his defence of the NHS last week, Andy Burnham emphatically stood Labour on a national pedestal against the threats of Conservative localism and the proverbial 'postcode lottery'. But, as the LGIU have argued, these dividing lines of political rhetoric set up a false dichotomy.

In decades past, desperate need for NHS reform - reduction of waiting lists, modernised equipment, effective commissioning - was met through centralised target setting and performance management. Now, the call for enhanced professionalism, more personalised services and public involvement in decision making heralds a more localised NHS, tailored to personal need and social circumstance.

And the NHS innovation agenda, trailblazed by Lord Darzi in his review last year, centres around more locally led innovation, enabling local services to respond to the needs of their community by introducing new responsibilities, funds and prizes to support and reward innovation at a local and regional level. As standards are higher, waiting times reduced and equipment more up to date, new priorities have steered towards a local direction in policy making.

Nowadays we want flexible, adaptive services that can respond to local demands, particularly in an economic downturn that shadows a bleak forecast for public service budgets. But alongside this we want the assurance that national standards will still apply and that we wouldn't be caught out if our social, economic or geographical circumstances changed. We want an NHS guided by fairness, but understand the value of local provision.

As a really good report by the Social Market Foundation asks - would people accept difference between areas if they felt fully involved in decisions about where to put resources? As LGIU argue, it is possible to imagine minimum national standards whilst allowing local services to decide how to prioritise, procure and provide them. Involving the public in the design of services they need might grant this legitimacy - and might reveal new opportunities to meet our demands.