Former Oldham chief: Central government ‘bubble’ risks poor policy making

Former Oldham MBC chief Carolyn Wilkins talks to LGC about her time in Number 10 and why local government can be a frustrating partner

For Carolyn Wilkins, walking each morning through the big black door into 10 Downing Street to work on ways the NHS and social care could become more joined up was a “real privilege at an extraordinary time”.

After all, few former council chiefs get the chance to witness close up the very centre of government operations.

The five months she spent as a Number 10 advisor was her second stint in government, following an 11-month secondment from her role as Oldham MBC’s chief to director of the ‘contain’ strand of the NHS Test & Trace programme at the height of the pandemic.

Ms Wilkins tells LGC she had been planning a “bit of a break” after leaving Oldham in August 2021 before starting her current role as chair of the Centre for Local Economic Strategies (Cles). But when she was offered the chance to advise Downing Street on the health and care integration white paper she dived straight in.

Getting Downing Street to understand the complexities of the adult social care system was “definitely difficult”.

“As a starting point if you frame the issue through the lens of the Care Act which is looking for the best possible outcome for every adult – the wellbeing agenda – that’s a very different lens from the constitutional and performance standards of the NHS,” she says. “That’s not to say people in the NHS aren’t bothered about wellbeing, of course they are. But that’s not their presenting issue.”

“The real challenge for central government is that it risks building policies that aren’t grounded in reality”

Ms Wilkins also had to get the centre to understand certain “nuances” such as what having a single accountable officer for a pooled budget means for NHS funding versus local authority funding, because council chiefs do not vote on council funding, their elected members do. It is a topic Ms Wilkins was familiar with, having combined being chief executive of Oldham MBC with the role of accountable officer of Oldham CCG for three years.

There was a “really low understanding” within Whitehall of the “statutory responsibilities of officers such as public health directors and chief execs”.

“We have our own legal responsibilities that we need to fulfil, and that’s not well understood,” she says.

Ms Wilkins recommends the sector spends more time framing what legal, statutory and political priorities people within those roles have – “whether they’re national or local political priorities, sometimes we launch straight into having to do things without considering that,” she says.

Ms Wilkins’ job involved briefing then prime minister Boris Johnson directly, and despite his reputation at the time for not grasping finer policy detail she found him to be “really focused” on the integration issue with a “good grasp of it”.

However, she found within the Number 10 team more generally as well as Test & Trace there was a disconnection from the reality of poverty in communities, and the “sense of a bubble”.

“Local government is so close to communities, and sees poverty on a day to day basis. The real challenge for central government is that because it doesn’t, it risks building policies that aren’t grounded in reality.”

Ms Wilkins took on her first stint in Whitehall, working for NHS Test & Trace, partly to “share some of the frustration” local government has of the sector’s voice not being heard loudly enough by the ­centre. “And anger,” she says. “It was more than frustration, certainly at the beginning of the pandemic.”

However, she soon came to appreciate that while policy shaping is “complex at a local level”, at the national scale “the complexity is even greater”.

“You’re dealing with devolved administrations, thinking about what happens in Scotland and Wales and also what’s going on internationally. But also, there isn’t a ­single voice from local government.”

She highlights the problem of turn­around time for covid tracing that arose during her Department of Health & Social Care secondment.

“There was real frustration on the ground about how long it took for our [public health] teams to get the information from the national trace team,” she says.

The national team looked at providing the data within 48 hours and if possible within 24 hours, but then a local public health team objected this would be “too quick” and they “couldn’t cope with that”.

The national team asked Ms Wilkins if the process should be slowed down, but she disagreed.

The dilemma demonstrated succinctly how public health teams “all have different capacity and different challenges”, with “no such thing as a single standard team”.

“In some places they share a DPH or only have a part-time public health consultant.”

Ms Wilkins recalls feeling frustrated when asked by her test and trace colleagues why some public health departments had skeleton staffing levels, leaving them ill prepared for a global pandemic.

“Well, 12 years of austerity! That’s why people have made some of these changes,” she says.

Ms Wilkins was also able to witness from the centre’s perspective the ongoing wranglings between counties and districts in two-tier areas.

The contain outbreak management fund, worth over £2bn in all, was handed to counties which prompted ire from districts who wanted the money paid directly to them.

“But not all districts wanted that – some had good arrangements with their counties,” Ms Wilkins recalls. “Whenever you come up with a solution to a problem, it just doesn’t fit somewhere.”

She believes bodies representing the sector including the Association of Directors of Public Health and the Local Government Association are “all working really, really hard to try to distil that down”. “But there are differences which the LGA has to manage all the time.”

Because of the national roles she has undertaken, Ms Wilkins now has more appreciation of the flexibilities councils have to innovate at place level while the NHS is still somewhat constrained by its national structure.

“Trusts can do a lot, but there are limitations,” she says. “You’ve got national infrastructure for food procurement and local recruitment, all sorts of things where we’ve got flexibility as local authorities.

“I don’t think I appreciated before the autonomy we have. Obviously you’re translating what elected members want to see, but you haven’t got to get it through the Treasury which is sometimes a challenge for Whitehall.”

The integration white paper when it was published in February was praised by many in the sector for focusing on arrangements at place level, which was perhaps partly thanks to Ms Wilkins’ role as an ardent champion of ‘place’ and its impact on wellbeing. She believes a shift is happening within the NHS to consider place more prominently. “I know a lot of NHS trust chiefs are interested in that,” she says.

However, Ms Wilkins admits the “focus on place was hard won” in the white paper. “I don’t think it says anything startlingly new, but it grounded the possibility of some of these things.”

She is pleased not only that place featured “centrally” but that the paper includes a joint foreword between the then health secretary Savid Javid and then levelling up secretary Michael Gove “connecting levelling up with integration”. She believes “we could make much more of the two [departments] working together”.

Ms Wilkins’ experiences in Whitehall have made her wish she had worked more closely with the centre herself when she was a council chief. But she believes Greater Manchester’s combined authority structure made it more difficult to do so.

“There is a question with combined authorities about how central government connects at the combined authority level, [but not] the boroughs that make up those combined authority areas – whether a little bit of that had been lost somehow,” she says. “Having those personal relationships with people you could just talk things through with. A more blended approach between government central and local would have been good.”