Devo-very-max? Wiltshire Council's bid for independence and a takeover of health provision

Written by Tony Millett on .

At Tuesday's (September 29) meeting of Wiltshire Council, Councillor Jane Scott revealed the basis for her 'ongoing discussions' with central government for an across the board devolution of powers from Whitehall to Trowbridge.  The devolution plan has been drawn up in response to the Chancellor of the Exchequer's call for local authorities to draw up 'wish-lists' by the beginning of September.

Councillor Scott's aim is to make the county independent of the annual and dwindling central government grant - by taking the full business rate income into the Trowbridge coffers.

The plan is called ONE WILTSHIRE and runs to 22 fully illustrated pages - with lots of smiling faces.  Much of it is written in traditional Wiltshire Council-ese.  But it is clear - that the governing party in Trowbridge wants to create "A council that is independent of central government grant."  

The document makes a series of promises/ commitments in most areas of the Council's activity, with each one followed by a list of what it needs the government to do to make those commitments/promises achievable.  An accompanying minute to the Council meeting says that it "does not commit the council to any of the proposals contained within".

While some of the statements are crystal clear, this summary sentence begs a few questions: "This document sets out our proposals for devolution to Wiltshire - empowering local agencies to work more closely together and to plan for the future - and in turn protecting the vulnerable, boosting the local economy and strengthening our local communities."

The document certainly makes it plain that even with so much more responsibility in its hands, the Council intends to continue as "One unitary council led by a strong cabinet and leader model."  There is to be no return to all those niggling committees.

One thing that immediately catches the eye is the sudden re-badging of the Council's campus programme.  Corsham's Campus - the only one fully open so far - is now to be known as The Health and Wellbeing Community Centre.  And it will have a key role to play in delivering health and social care services.

And one of the main areas covered in this document is the delivery of health services.   The proposals include delivering 'population place based budgets, incentivised to improve prevention', and 'blending health and social care funding to create integrated personal commissioning budgets...'

The document states: "Wiltshire has a very strong Health and Wellbeing Board."  This is strange because the HWB has no staff and takes no executive decisions - as a committee of the Council it just approves plans. But it is clear that Councillor Scott intends the HWB to run the county's health and social care.

The lauding of Wiltshire's Better Care Plan - 'which will divert significant demand away from acute hospitals' - comes as NHS England is calling for the sums taken from the NHS budget to support the social care part of the BCP to be frozen at current levels.

It also lauds the Council's Help to Live at Home scheme - with its record of abbreviated and missed home visits - just as the National Institute for Health and Care Excellence (NICE) is calling for standardised 30-minute home care visits.

There is even a call to devolve the funding of Health Education England so Wiltshire can train the health workers it needs.  We are not yet told what would happen if a Wiltshire-trained nurse wanted to move to Oxfordshire.  One can envisage a whole new bureaucracy working out cross-payments.  

The document seems utterly oblivious to the current and fast developing nationwide NHS funding crisis.  Nor does it specify what role the Clinical Commissioning Group will have in the One Wiltshire devolved future.

There is also a request for the Treasury to make it possible for the community health hospitals to be transferred - once PFIs have been bought out - from the ownership of Great Western Hospitals Foundation Trust (where they rested as part of the Lansley NHS restructuring) to Wiltshire Council.  

On the face of it this is an extraordinary intervention into a costly on-going tender process for the adult community care contract currently held by GWH.  It is not made clear how this will affect the budgeting of those applying to run this important contract.

On governance matters, the devolution proposal says the Council will "Ask the Local Government Boundary Commission to review the number of Wiltshire Councillors."  This rather pre-supposes Councillor Scott wants to reduce the number of councillors and so save on their annual cost - in 2014-15 it was £1,851,612.

Any reduction in representation would dilute democratic accountability just as the Council took on many more responsibilities.  But if you do without a committee structure, you need fewer councillors.

A reduction in councillors might, for example, mean that the Marlborough Area goes from four to two councillors - one for the town and one for the villages.  But this would mean the Area Board - to which this devolution plan is giving more powers and more work - would have just two voting members.  That would be unworkable.

Once again the Big Society - or at least its offspring - is called on to help out with one of the plan's aims stating: "Increasing the involvement of volunteers and the voluntary sector in public services."  Elsewhere a bubble graphic says: "Increasing volunteering levels and easier secondments between public sector services."

There are other sections of the plan on the county's economy, education, a better north-south road link, and housing.  Even in outline it is a very complex, multi-tiered plan.  It can be read in full here.