HSJ 'Managers make the difference' campaign: HSJ's campaign charter stresses the responsibility and capacity of NHS managers to engage stakeholders outside the NHS. To mark the launch of an exclusive briefing paper, Colleen Shannon looks at the complex relationship with local government and MPs

The health service has always been a political football and it probably always will be. That's the view of many politicians; it's certainly the opinion of Kevin Barron, MP for Rother Valley and chair of the Commons health select committee.

It is a reality acknowledged by leaders in the NHS, as well as at Westminster and in local government. Increasingly, the ability to work effectively with politicians is becoming an essential survival skill. When it is done poorly, the penalties can be severe. If a hospital is in difficulties, an alienated MP can destroy its reputation on the floor of the Commons and turn a local newspaper headache into a national media nightmare. Managers in the NHS are 'easy prey' for undeserved attacks from MPs, Mr Barron says.

Local government is also increasing its leverage. Since 2001 councils have had wide powers to challenge and even block NHS plans. Upset them enough and local government overview and scrutiny committees can refer their complaints to the health secretary.

But when the game is played well, the rewards can be enormous. Take, for example, University Hospital Birmingham foundation trust. After eight years of planning and negotiations, a new£559m private finance initiative 'super hospital' has finally received the green light.

Close working with councillors and MPs has been crucial in winning local and national approval for the scheme. It has also benefited the community by building the local infrastructure and boosting employment, says Mike Sharon, deputy director of policy, planning and development at the trust.

As part of the new project, a skills academy will provide training for employment in both the building trade and the NHS. The hospital is also part of a planned high-technology corridor running down the M38 motorway, which is intended to offer new jobs for local people and attract further investment.

The hospital is being built in Councillor Deirdre Alden's ward and she has been monitoring its progress for several years. She says local people see the need for a new hospital and believe it will be good for the area in the long run.

For now though, she says, part of her job is to help constituents living on the edge of an enormous building site. 'Everyone likes the end result, but it's going to be a very difficult few years. It's a huge project and it's smack bang in the middle of a residential area,' she says.

A procession of lorries, a shortage of parking spaces and noise are some of the issues that residents have been talking to her about. Ms Alden says the trust has made good efforts to keep in touch with its neighbours and address their concerns as far as possible. She also needs to look out for the interests of her constituents in the longer term and to take a strategic view, as chair of Birmingham city council's health overview and scrutiny committee. To this end, Ms Alden intends to monitor the number of beds that materialise so that her constituents get the level of service they have been promised in exchange for the disruption they are now enduring.

To get the plans through final DoH approval, the trust had to put three 36-bed wards on hold. They will be built but not used until a later date, assuming activity levels increase. 'I don't want it to be a situation where we have a new hospital built and part of it is empty,' says Ms Alden.

Great advocate

Also keeping a watchful eye will be Gisela Stuart MP, a member of the UHB board of governors and a former health minister. She has been an invaluable ally for the hospital over the years, says Mr Sharon. 'Gisela has been very committed to the project and has been a great advocate for Birmingham.'

She believes relationships between NHS leaders and politicians should be built up over a long period and carefully nurtured. She makes a point of remaining in contact with managers even when they leave her patch to work elsewhere in the NHS. They can provide a valuable sounding board and a reliable picture of what is really happening in the NHS from day to day, she says.

The Birmingham experience is being replicated ? although usually on a more modest scale ? in other parts of the NHS. In counties and inner cities alike, common themes arise: cultivating relationships over time, transparency, and looking for shared priorities.

In south London, Lambeth primary care trust chair Jane Ramsey recently had cause to be grateful for help from local MPs and councillors in seeing through the relocation of a GP surgery, to the eventual satisfaction of the area's residents.

'It was absolutely worth taking a bit of extra time to meet with local people and politicians before finalising the move,' she affirms. This is just one example of the way in which the PCT works with councillors and MPs on issues such as commissioning and service reconfiguration.

She does not wait until problems arise, though, and meets with local MPs about twice a year to exchange updates. 'They also know that if they want to pick up the phone and say they have an issue with constituents or if they send letters asking for responses, then we are prompt and we take that business seriously,' says Ms Ramsey.

Far away from inner London, in Derbyshire, High Peak and Dales PCT chair Dianne Jeffrey is another believer in relationship-building and communication. In the face of a staff shortage and the constraints of its financial recovery plan, her PCT had to withdraw night-time cover for a minor injuries centre. The decision had to be taken at short notice. Knowing the news would make constituents anxious, she was prompt to contact local politicians and explain the situation.

'It's also important at times like this to contact the opposition candidate and get them on board,' says Ms Jeffrey. 'We can provide a perspective that's rather more patient focused and not politically motivated.'

East and North Hertfordshire trust chair Richard Beazley meets regularly not only with MPs and councillors but also with local newspaper editors. It is part of an strategy of openness that he has led alongside trust chief executive Nick Carver. Unless there is a matter of patient, commercial or staff confidentiality, 'everything we say is on the record', he says.

Once in a while, alongside all the hard work there is simply a happy convergence of history, personalities and priorities.

The NHS in Rotherham was ahead of its time in tackling health inequalities and focusing on health improvement, says local MP Kevin Barron. Programmes that predate the latest public health white paper by many years are still going strong and some, such as a popular exercise and lifestyle club, have been kept alive by local people even though the funding has expired.

NHS ties to the MP were also forged long before the current government came to power. 'In the many years I was in opposition, my relationship with the local health community was no different than it is now,' says Mr Barron. 'I may have had some disagreements, but it was mostly because of what they were being instructed to do from a higher level.'

Mr Barron has a track record of his own in public health and has been a high profile anti-smoking campaigner for many years.

Similar priorities top the agenda at the town hall. Councillor Robin Stonebridge, who chairs performance, scrutiny and overview for Rotherham metropolitan borough council, believes that non-executive directors at trusts should be looking after issues such as budgets, commissioning and supplying services for patients (he was once a non-executive director of Rotherham PCT). Local government should be more concerned with health improvement.

'It's about a difference of focus,' he says. 'We need to ensure that overview and scrutiny doesn't duplicate the role of boards,' he explains. Developing the local strategic partnership has helped move the work in this direction.

As one success, he cites a scheme to improve access to high-quality health information. This links libraries, the expert patient programme and adult education. Getting older people online, for example, allows them to find out the nutritional values of different foods. Being able to shop for healthy food on the internet is a spin-off benefit.

Another joint venture between the NHS and the council addresses the area's post-industrial legacy of lung disease. Breathing Space is a new multi-million pound unit that specialises in supporting people with chronic obstructive pulmonary disease. In addition to medical care, the unit provides a link to social services and the voluntary sector. Mr Stonebridge attributes the project's success to the fact that the NHS and local government identified a shared priority.

Obesity, mental health, drug and alcohol abuse, sexual health ? all these issues can only be addressed through joint-working, Mr Stonebridge says: 'They're not things people can tackle alone.' This work will have a lasting legacy, rather than disappearing 'like a puff of smoke' with the next NHS reorganisation, he adds.

'I've always worked closely with the local authority,' says Rotherham PCT chief executive John McIvor. 'This has been an area of great deprivation and that's not just an NHS responsibility. To improve the health of the local population we are but one of the players.' He adds: 'We can get more bang for our buck if we spend money jointly than if we go it alone. We can get more health improvement if we invest together.'

Harnessing the resources and influence of local politicians speeds things up. 'Working with others pays huge dividends and we make progress more quickly,' he says. This applies to many goals, from cutting waiting lists to reducing levels of heart disease.

Could do better

While it is worth highlighting the good news, many politicians and observers talk about the 'democratic deficit' and think the NHS is not as accountable to the public as it should be.

The NHS needs a stronger message from the health secretary about the importance of working closely with local government, says Judy Seager, deputy leader of Wiltshire county council and deputy chair of the Local Government Association's community well-being board. There are extremely challenging and potentially divisive issues, including NHS budget deficits and PCT reconfiguration in some areas, says Ms Seager.

Many organisations are missing an opportunity to link councils with patient and public involvement forums, suggests NHS Confederation deputy policy director Jo Webber. It is about 'how you engage people in what's going on', she says. 'Local authorities are very good at doing that and they have mechanisms for getting to some of the hard-to-reach places.'

These lessons will have to be learned not only by trust chief executives and chairs but also by staff at many levels in NHS organisations. Politics is usually seen as the provenance of senior managers, but as local government overview and scrutiny becomes a routine part of work in the NHS, middle managers and clinicians will find themselves in the hot seat once in a while too.

Ms Webber suggests that NHS staff should be exposed to political situations in preparation for more senior roles. Clinicians can also be credible and effective advocates for change.

Experience is proving this point. One trust chair was pleased recently to see staff acquitting themselves very well before local councillors. 'Trust staff, managers and clinical leadership have built on the open communications we developed,' says East and North Hertfordshire trust's Mr Beazley. 'They were really very impressive and I was proud of them.'