What do the local election results mean for the NHS?

On Thursday, voters in 259 councils across England and Northern Ireland went to the polls. While most councils remain under Conservative and Labour control, there have been several major changes.

The Liberal Democrats have taken hundreds of council seats, along with independent groups and individuals. Their success has come mostly at the expense of the Conservatives, who suffered a loss in excess of 1,000 seats.

The elections have handed control of 11 more councils to the Liberal Democrats and three to independents. Thirty six fell into no overall control.

Of the 149 larger councils (metropolitan, county, unitary and London) 66 are now Labour controlled, the Conservatives have 48 and the Liberal Democrats four, while there is no overall control in 30.

Change has been even more significant in the 192 district councils. Here the Conservative lead the way with 95, followed by Labour 25, Liberal Democrats 19 and independents 5. One of four district councils now have no overall control.

In many councils, the ruling Conservatives or Labour parties now have very thin majorities.

These results have wide-reaching consequences for social care and community health initiatives.

With relatively few councils under their control, the Liberal Democrats’ approach to health has been somewhat of an unknown quantity. Even more unpredictable are the policies of the independent councillors, whose stances vary widely council-to-council.

The success of minor parties and independents paints a mixed picture when it comes to funding priorities and backing for sustainability and transformation partnerships.

To STP or not to STP?

STPs have remained controversial since their announcement in 2015. For some, they have been a smokescreen for further healthcare cuts. Their defenders claim that lessons have been learned and that they can facilitate a more joined-up approach across local authorities.

Conservative losses have removed many of the most STP-sympathetic councillors from office. This may result in a rather frostier reception for STPs in the coming years.

The Liberal Democrats’ approach to STPs has been divided. Some leading councillors have welcomed the opportunity to highlight neglected areas of healthcare. Newcastle councillor Dr Wendy Taylor wrote that, while STPs were forced to include “unrealistic financial savings” in their plans, they could also be used to “push for more to be spent on preventing ill health and reducing admissions to hospital”.

Others, however, are opposed; the North Devon Liberal Democrats have rallied support against the implementation of their local STP. On Thursday, the Liberal Democrats gained North Devon from a Conservative-Independent coalition.

Due to many councils falling into no overall control, consistent public health strategies will become ever harder to produce

There is great variation amongst the politics of independent councillors, so their stances will vary from council-to-council. But the most successful groups have positioned themselves as anti-Labour parties.

Ashfield Independents, who swept to victory with 30 out of the 35 Ashfield seats, campaign against Labour “wrecking” the council, whereas Mansfield Independent Forum have previously worked in coalition with the Conservatives.

Nevertheless, these groups’ priority is localism and, due to the perception of STPs as a top-down process, they are less likely to be supportive than Conservative councils.

Spending limitations

The truth about local government in 2019 is that there is little money to spend, irrespective of party affiliations. Central government support has fallen by 49.1 per cent since November 2010 and council tax increases have not managed to plug that gap in its entirety.

Whether the local election results will lead to more funding, or at least a smaller reduction in spending on social care is an open question.

Liberal Democrats or independents are not necessarily more likely to spend than other councillors. Although there is a dearth of party-specific spending data, findings from the Centre for London illustrate an interesting, albeit geographically limited, trend.

Labour councils spend by far the most per-capita across the board, while Conservatives opt for lower spending-levels. Liberal Democrat councils and those under no overall control consistently spend least.

A change of strategy?

Due to many councils falling into no overall control, consistent public health strategies will become ever harder to produce. But there are some early indications about the focus of Liberal Democrat and independent councillors.

The Liberal Democrats have drafted a set of policy proposals and best practice for their councillors. A key theme is community action, such as Sutton Council’s local HIV testing campaign. They also focus on preventive measures and integrated social care.

A more classically liberal approach is prioritising information and individual choice. Several suggestions focus on highlighting the health implications of smoking, drinking and fast food.

Councillor Richard Kemp goes further, asserting that: “There are times when we must be absolutely blunt in telling people that they are themselves a major cause of their own ill health. The prime responsibility for good health lies with the individual or in the case of children their parents.”

Notable independent-controlled councils, such as Mansfield, have focused on the integration and funding of adult social care. The independent councillor’s group in the Local Government Association support preventive care and further investment into children’s social care.