In Sickness and in Health
Assessing the transition to a more localist health system- the first step towards marriage between the NHS and local government
Author: Gwilym Tudor Jones |
In Sickness and in Health
Assessing the transition to a more localist health system – the first step towards marriage between the NHS and local government?
Localis, in partnership with Pfizer, has published a major new report which assesses the recent move to a more localist health system and uncovers a real spirit of optimism in local government, with 96% believing that their council will improve the health of their residents. This report takes stock of how councils have adapted to the return of public health to their portfolio and the dismantling of barriers between health and social care.
April 2013 saw local government assume a major new role in health services, with 2.7 billion of public health funding switching from NHS control into the hands of local authorities, and the creation of new Health and Wellbeing Boards which enhance the role of councils in the planning and oversight of all local health services. And the report raises the possibility that the future could see an even closer marriage of health and local government with councils assuming greater – even complete – responsibility for health commissioning.
Informed by a survey of over 80 senior local government leaders, ‘In Sickness and In Health’ finds (formerly NHS) public health teams successfully working alongside their new local government colleagues to focus not just on the traditional big public health issues such as sexual health, obesity, smoking cessation but to explore new and innovative ways to tackle the wider social, cultural and environmental determinants of health.
The report’s principle recommendations are:
Firstly, local authorities cited confusion over data sharing procedures as a significant barrier to integration. To enable effective collaboration between local authorities and health colleagues, the report therefore recommends that the Government should move to a presumption in favour of data sharing between all local partners.
Secondly, the report suggests the Government should consider making the Minister for Public Health a joint Department of Health/Cabinet Office position, in order to aid integration across departmental silos and make a statement that it is embedding public health at the heart of all its policies.
Thirdly, the report finds some councillors fear that they will not have the necessary levers to adequately affect decisions about local health services. To address this perception, the report recommends that the Government review the operation of the new health system in 2015 to ensure that Health and Wellbeing Boards have real influence, and, if their democratic voice is not heard, look at expanding councils’ powers over health commissioning.
The report has attracted support from within the health sector and across the political spectrum:
Norman Lamb MP, Minister of State for Care and Support, said ‘This report is a welcome addition to the ongoing discussion and work on integration. It shows how the health reforms, introduced in April, were designed to put integration at the heart of the health and care system. The reforms have presented a great opportunity for local commissioners to join up services so that they put the needs and preferences of local people first.’
Rt Hon Stephen Dorrell MP, Chair of the Health Select Committee and former Secretary of State for Health, ‘welcomes this timely study of the implications of greater engagement between local government and the full range of health and care services.’
Clive Betts MP, Chairman of the Communities and Local Government Select Committee, asserts that the report ‘offers useful recommendations on collaboration between health and wellbeing boards and clinical commissioning groups, on holding GPs and NHS England to account and on how councils can embed public health in all local services.’
Professor Sir Michael Marmot, who chaired the Government-commissioned review ‘Fair Society Healthy Lives’ (2010) – a key driver behind the reforms – said that the report ‘provides advice that will give local authorities across England valuable direction and guidance.’
Launching the report, Localis Chief Executive Alex Thomson said:
‘Local government has a long and proud history of improving the health of the nation so these reforms represent a real homecoming. It’s heartening that there is such a sense of optimism about the opportunity to once again help local people live longer, happier lives. Things are looking good so far, but only time will tell if additional powers are needed.’