The public health transition: a big bang or damp squib?

Blog Post by Phil Swann, Programme Director, Shared Intelligence and Proposition Facilitator

The public health challenges facing the country were cogently set out in the Marmot Review. Locally some communities face particularly pressing problems and many local authority areas encompass stark health inequalities.

In many respects the council wheel has turned full circle. Local government’s roots lie in responding to the public health challenges of the late 19th and early 20th centuries. Today’s equivalents – ranging from childhood obesity to sexually transmitted diseases – increasingly dominating local priorities.

One strand of the coalition government’s health reforms reinforces the role of councils as public health organisations. In short, responsibility for public health is transferring to local government – together with ring-fenced funding – and new health and wellbeing boards are being established to secure an integrated and collaborative approach at a local level.

The jury is out on just how significant these changes are. Some people see the public health transition and the new boards as a significant opportunity to restore local government’s role at the heart of the public health role with potentially significant gains for local communities. Others question the extent to which these arrangements will have real traction in relation to the old NHS beasts in the form of the acute sector and the new beasts in GP commissioners and detect powerful centralising tendencies in, for example, Public Health England.

The health strand at the SOLACE summit will unashamedly aim to influence the jury. It will test the proposition that the public health transition represents a significant opportunity for local government to do more to improve the health and wellbeing of local communities. It will also explore what needs to be done in order to ensure that this aspect of the government’s proposals is indeed an opportunity and that it is exploited to the full by local councils and their partners to the benefit of local people.

Questions which might be explored include:

Is there a shared understanding of what public health means today and what the relevant levers and policy instruments are?

How do local councils need to change in order to be able to enhance the effectiveness of the public health role?

How can Health and Wellbeing Boards gain more traction in terms of mainline services and actions than most LSPs and thematic partnerships did?

How should the local public health function relate to other features of the changing health landscape, including Public Health England, mental health trusts, the acute sector and the new commissioning arrangements?

Do the new arrangements provide for a new relationship with the voluntary and community sector in relation to public health?

There is a strong case against simply “lifting and shifting” the public health function from PCTs to local councils, but what are the building blocks of an alternative approach?

What is the role of local politicians and local political leadership in all this?

Initial thoughts on these questions and others are very welcome and will help to shape the shape and content of the discussion in Edinburgh.

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4 Responses to The public health transition: a big bang or damp squib?

  1. Robert Hardy says:

    An interesting piece Phil covering some of the key questions. I think there is (at least) one more dimension to add to the debate for those working in two/three tier local government areas.

    Many of the mechanisms to support pro-active preventative public health action sit at a district or parish level through play, leisure, sport, cultural services etc whereas the expertise in commissioning personalised services and interventions sits mostly with the county (and PCT). Will districts and parishes be treated solely as providers commissioned by county-level structures or will their knowledge and expertise be harnessed as part of the commissioning process?

    I therefore think that another challenge for the health and well being boards (and another parallel with the history of LSPs) will be the need to work through both the service delivery and governance relationships between and amongst up to three different ‘local councils’ at both officer and Member levels.

  2. Abdool Kara says:

    Good post Phil, and helpful response Robert. I would add two points:
    (i) Robert missed out housing as probably the biggest single influencer on public health that sits at district council level – joining up health and housing seems an absolute no-brainer to me, possibly through local (ie district level) HWB Boards; and
    (ii) I was uncertain what Robert meant re ‘up to three different local councils’ in his post. There is both a vertical problem (county, district, parish/town councils) and horizonal problem (in the absence of a ‘rule’ that Clinincal Commissioning Bodies need to be co-terminous with district council boundaries). I know that the govt has committed to co-terminosity at county level in two-tier areas, but we really, really need this to go further to DC level otherwise all our efforts will go into stitching governance together rather than delivery on the ground.

  3. Alex says:

    In Scotland we have devolution, and differences. These may be worth exploring at your Conference.

    In November 2007 national and local government signed a concordat, which committed both to moving towards Single Outcome Agreements (SOAs) for all 32 of Scotland’s councils and extending these to Community Planning Partnerships (CPPs).
    The Scottish Government and local government share an ambition to see Scotland’s public services working together with private and voluntary sector partners, to improve the quality of life and opportunities in life for people across Scotland. Single Outcome Agreements are an important part of this drive towards better outcomes. They are agreements between the Scottish Government and CPPs which set out how each will work towards improving outcomes for the local people in a way that reflects local circumstances and priorities, within the context of the Government’s National Outcomes and Purpose.

    Scotland now has 32 Community Planning Partnerships, although I would hazard a guess that most people do not know what they are. They may not yet have helped ordinary people feel they can influence local matters.

    With regard to Health, in Highland there has been a decision that seems to say, let the Council take care of you up to 18, and the NHS thereafter
    A Special Joint Meeting of Highland Council and the Highland NHS Board will take place in the Council Chamber, Council Headquarters, Glenurquhart Road, Inverness on Thursday, 23 June 2011 at 10.00am.

    You are invited to attend the meeting and a note of the business to be considered is attached.

    Yours faithfully,

    Michelle Morris
    Assistant Chief Executive (Highland Council)

    1. Apologies for Absence

    2. Declarations of Interest

    Members are asked to consider whether they have an interest to declare in relation to any item on the agenda for this meeting. Any Member making a declaration of interest should indicate whether it is a financial or non-financial interest and include some information on the nature of the interest. Advice may be sought from Officers prior to the meeting taking place.

    3. Planning for Integration – Development of a Lead Agency Model in Highland for Care Services

    There is circulated Joint Report No. HC-NHS-2-11 dated 16 June 2011 by the Chief Executive, Highland Council and Chief Executive, NHS Highland, which confirms that the Highland Council and NHS Highland Board have agreed to develop a Lead Agency Model for the delivery of aspects of services to children and families and adults and sets out further detail behind these models and a proposed Governance framework which includes some guidance as to how commissioning would be developed.

    Council Members and NHS Directors are asked to:-

    (i) agree the development of an Integrated Children’s Service with the
    Highland Council as the Lead Agency;
    (ii) agree the development of an Integrated Adult Service with NHS Highland
    as the Lead Agency;
    (iii) agree the proposed model of Governance;
    (iv) agree the approach to Commissioning;
    (v) confirm that the outcome agreements and commissioning documentation
    should be the subject of further reports to the Board and the Council; and
    (vi) continue to support the programme of implementation.

  4. Ruth Hyde says:

    I was fascinated to listen to the radio 4 programme recently “The first 1000 days: a legacy for life” ( podcast here) . This looked into the latest recearch findings on the origins of chronic ill health and highlighted the fact that the old “nature or nurture” dichotomy is well and truly out of date, since it is the interaction between genetic and environmental factors which play such a big part in determining health outcomes in individuals, and indeed in communities. The other powerful point made was that the seeds of an individual’s ill health are laid down up to 100 years previously and are impacted by such factors as the nutritional status of a person’s grandmother. In the light of these emerging facts it seems absolutely right that responsibility for public health is returning to local government, which is well placed to take a wider view of the determinants of health and can help to design interventions which can identify and seek to address the health vulnerabilities of groups who currently enjoy much poorer health outcomes than others.Politically led organisations however sometimes struggle to address long term issues as they are predisposed to seek short term political electoral advantage ,so Councils ( especially in the current funding context) are perhaps going to struggle even more than PCTs did with the task of balancing the immediate and pressing demands of ill health – particularly with the growth in the ageing population and dementia related illness with the investment required to lay down the foundations for future health improvement, breaking cycles of inter-generational inequality and ill health.

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