Nick Denys is a leading member of Platform 10
Should local authorities take on public health duties? My answer to this is an emphatic yes. Different areas have different needs and will require specific – local – solutions. The second question is are local authorities ready? I suspect the answer to this is that some will be better prepared than others, but you cannot wait until everyone is ready otherwise responsibility will never be devolved.
What role will central government play? The centre should communicate the good ideas that are out there. If council X is doing well, this should be highlighted. If council Y is not doing so good then they can learn from others. If Y does not react appropriately then, hopefully, local people will put pressure on them to do so. In a sense this a macro version of peer pressure, but it will only work fully if there is real local accountability.
Councils need to consider how to outsource projects: Other local actors can play a role in improving public health – they might have good ideas about what motivates those that are trying to be reached. It will be interesting to see how different councils operate their tendering process and how they gather ideas from the community. Local authorities have a great chance to use PR to both promote the fact that they are now responsible for this and show that they are open to advice [and] local ideas.
Letting go of power always seems to be a hard thing to do: Under these proposals it is not a key policy aim for a person in Cornwall to get the same service as they would in Cumbria. I celebrate the fact that this is not guaranteed. The concept that the government's priority should be that, from John O'Groats to Land's End, there exists a homogeneous system is both undesirable and unachievable. But the state still has a hugely important role in ensuring basic standards are met and that those who succeed pass on their lessons to others. Localisation can only work if those that are under-performing are given a realistic opportunity to improve.
Belinda Wadsworth is the strategy adviser for local and regional policy at Age UK
Preventative measures, especially for older people, could play a part: Falls prevention, social isolation, malnutrition, physical activity and preventing excess winter deaths should all be part of the agenda of the health and wellbeing boards. And the key thing is that local government can ensure that these issues are addressed in the round by bringing the work of different parts of the council (both county and district) together.
Richard Humphries is the lead on social care at health charity The King's Fund
Ring fencing works both ways: Public health professionals worry that without ringfencing councils will spend the money on something else and local authorities worry that not enough public health money will be transferred to them (understandable in view of past experience of other transfers of central govt money). Either way, the important thing is not to argue about it but [to have] councils and public health professionals map what they are spending at the moment to get the baseline right from the beginning.
One person's localism is another person's postcode lottery: Weekly bin collections offers a recent example of this. One theme that is emerging is the amount of variation across the country. When this is deemed unacceptable (not related to differences in local needs) it's not clear how this will be tackled in the brave new world.
Housing has an important role to play: Housing providers and commissioners should be actively engaged with health and wellbeing boards, even if they are not on the board. Pester your local authority about getting involved in health and wellbeing priorities, especially preparation of joint strategic needs assessments and the local health and wellbeing strategy. Also, assemble whatever local evidence you can muster of impact of housing on use of health and social care services.
Mike Birtwistle is managing director of MHP Health Mandate
Establishing a ringfence is attractive in theory but difficult to implement: The problem is that pretty much anything can fall within the scope of public health: school dinners, sport and leisure, road safety – you name it. At a time when councils are facing cuts in wider budgets, there will be a temptation to use public health funding to pay for other services. Our research shows that nearly half of all local authorities don't have a definition of public health, which will make it difficult to operate a ringfence.
Allocating funds to tackle health inequalities is fraught with difficulty: Do you weight for age, deprivation or existing ill health? What is the mix? Getting this right will be critical to making the health premium work. The good news is that most local authorities identify tackling health inequalities as a key part of their public health role. As they are close to local communities, they should be able to identify the most pressing needs and seek to address them.
There is a PR job to do: One of the challenges facing councils is that they often bear the brunt of local frustration with services. Local authorities need to show that they are making a difference on health by bringing together local partners. Malnutrition is a great example of where they could make a difference. Many of the causes of malnutrition start in local authority land – care homes, meals on wheels, day centres – but it is often the NHS which is left to pick up the pieces. Councils could make a real difference here.
Government needs to make up its mind about whether it wants local autonomy: National crack downs on local bin policies and indeed on councils investing in PR are somewhat at odds with localism. If we want councils to take on responsibilities, we need to let them do so. This is different, however, from not defining what the scope of those responsibilities should be at a national level.
Joint accountability and incentives are important: Take cancer as an example. The NHS and Public Health England share a domain of the outcomes frameworks (reducing premature mortality, with cancer as an improvement indicator). Early diagnosis will be important in achieving this and both public health (screening and awareness) and the NHS (GP referrals, access to diagnostics and prompt uptake of high quality treatment) need to be accountable, otherwise one could take an action which will destabilise the other.
Paul Dossett is a partner at accountancy firm Grant Thornton
A definition and budget is essential: Our experience of PCTs transferring aspects of public health services showed that there are both major disparities in what was spent by different PCTs on public health, and doubts over the accuracy of what was recorded in their books.
There will inevitably by higher costs if public health is to be delivered effectively: Clearly some experienced staff will join and many councils already have joint director posts in place, but I think councils will want to take time to scope out how the service will work in their area and what skills they will need.
You can read the full discussion here
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