Locality, Public Health and the NHS

The Government’s plans for radical change in the way in which public health is delivered in localities have changed less during the Government ‘reforms of its reforms’ than almost any part of its NHS programme.

There is a lesson in this rarely demonstrated ability to hold the line. Why is it that they have changed nearly everything else – including the national picture of public health – but have been able to stay constant on the radical change to localities?

Their policy on devolving responsibility for most of public health to local government has been maintained because – unlike other parts of their proposed NHS reforms – they plan to use an existing political organisation to carry out part of the reform. It may seem obvious given the political importance of local government to both national and local politics that if the Secretary of State decides to use local government to deliver some resources and powers, local government will support the reforms.

Compare this with other aspects of their reforms. In many areas of NHS reform the Government were either creating new organisations (GP Commissioning Organisations) or using organisations that do not have a history of mobilising political support (Monitor). Or, most weirdly as far as the public were concerned, were trying to give organisations powers and responsibilities that the organisations themselves did not want. Thus when the BMA and the RCGP started to attack GP commissioning, the public were bemused about the government’s reasons for handing over all this power to GPs.

As we have seen over the last year this is very bad politics and will always undermine the case for reform. If the very people the Government want to take on new powers do not themselves want them, why should the public trust the Government’s judgement?

But with the transfer of local public health to local government, the government were giving power, authority and resource to organisations that wanted power authority and resource and could carry out their duties.

In one form or other local authorities have existed and delivered services for at least 130 years. They know what they are doing, can take on board new functions – and just get on with it.

So the uncertainty and anxiety that exists in abolishing other parts of the NHS and giving their powers to organisations that, as of today do not exist, are not there for the transfer of local public health to local government.

Amid the skid marks left by the screaming tyres of Government policy U turns on most NHS reform this part, more than any other, has left the road to reform largely unmarked.

Its problem is not the politics of the reform but its practicalities. If you give most public health staff and resources to local government, what then will be the relationship between that activity and the NHS?

The consultation paper published in early July tried to go into more detail than had been achieved before. It was clear that it was maintaining the direction of the policy but had recognised that having given these powers to local government the relationship with the NHS had become a problem.

‘2.5 Locally, we will empower local leaders to shape their own approach to addressing local needs and tackling the wider problems that undermine health. Through health and wellbeing boards we will ensure that NHS commissioning plans are integrated with and reflect local joint health and wellbeing strategies. We will also ensure that the NHS continues to receive high quality public health advice, whilst encouraging NHS clinicians to use every clinical encounter to promote better public health.’

The document gives a lot more detail on how local government will carry this out,

‘2.15 During consultation there was concern expressed that the local government role in public health beyond health improvement was not clear. We can confirm that local authorities will have a role across the three domains of public health. The Health and Social Care Bill gives upper tier and unitary local authorities a new duty to take such steps as it considers appropriate for improving the health of the people in its area. We plan to give local authorities new functions through regulations for taking steps to protect the local population’s health, and for providing clinical commissioning groups with population health advice.’

Page 1 of 3 | Next page