The NHS has always had an uneasy relationship with local democracy. Caught between the competing demands of the system’s centre and their communities, STP leaders need to learn how to work with their locally elected representatives to maintain the equilibrium, writes Michael Wood

“Save our hospital!” “Keep our A&E!” – slogans like these cause sleepless nights for any NHS manager involved in system transformation. Yet, for every complaint about an MP campaigning against local hospital closure, I hear of several where they feel shut out of discussions.

Are we now at a tipping point?

Politics in the NHS largely takes place behind closed doors

It goes without saying that if decisions are to be devolved closer to the people, the people should have more say over them. It looks odd, quite frankly, for the health service to be separate from the challenging discussions about public service reform. Certainly, were I a newly empowered metro mayor, I wouldn’t shy away from getting involved in the inner workings of my local NHS.

And here I think is the trick.

With money tight, the grip of the NHS’s centre is becoming tighter. Operational efficiency risks unbalancing visionary leadership. The service needs to view local democracy as a counterweight, not as a further obstacle.

Place based leadership is not the same as sector based leadership. There are opportunities now for the NHS to “share” responsibility for the tough transformation decisions with other local leaders, particularly when running contrary to the wishes of the centre.

Furthermore, mayors, MPs and councillors have an intrinsic link with the public who, of course, also use our health services. They are quite rightly going to want what is best for local people. The key is to engage them in both process and strategy, and early and often, and get them talking to the community, not joining protests alongside them.

It’s not that there isn’t politics in the NHS. Far from it. It’s just that it largely takes place behind closed doors. Local discussions about what to bring out into the open, and when and how, might just enable our health service leaders to walk the seemingly impossible tightrope that both the centre and their communities expect them to tread.

Michael Wood is NHS local growth adviser at the NHS Confederation