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The Government’s health and care reforms involve a significant increase in responsibility for local authorities in England as they will be tasked with: commissioning public health services from a ring-fenced budget; integrating health and social care services through local health and wellbeing boards; and ensuring democratic involvement in health commissioning decisions

Much of this is not new.  Local authorities had responsibility for public health commissioning up until 1974 and they have continued to retain an important role in scrutinising delivery of health services at local level.   Local authorities are already involved in commissioning and delivering services which have an impact on health and wellbeing.  Housing, leisure services, licensing and school dinners, for example, all have a significant impact on population health.  

Healthcare policy consultancy MHP Health Mandate has published a new report based on a comprehensive audit of local authorities to assess their preparedness for their new health responsibilities.  Ready for health? an analysis of local authorities’ preparedness for health shows that, although some local authorities already have a strong interest in public health and have made significant steps in preparing their local health and wellbeing boards, many have some way to go.

Over 40% of local authorities were unable to define ‘public health’ despite the fact that they will soon be responsible for commissioning public health services through a ring-fenced budget.  Also, local authorities’ links with primary care trusts are patchy, with nearly a third (29%) of local authorities unable to confirm that they have had communications with their local Primary Care Trust about public health services within the last year. This is despite the fact that delivering integrated care will be a key task for local authorities.  Finally, although nearly 90% of local authorities identified themselves as early implementers of health and wellbeing boards, only 63% of respondents confirmed that they had undertaken an assessment so far to support the development of a board in their area. This indicates that there is still some way to go in translating the aspiration for these boards into reality.

However, the report also uncovered many examples of good practice which could be spread across local authorities.  Just over half (52%) of local authorities are already involved in commissioning and delivering public health services, receiving funding from PCTs to do so while most local authorities (75%) report that they share a joint director of public health with their local PCT.  In addition, half of local authorities reported discussing public health issues with other local authorities within the last 12 months which is encouraging for future joint working.

Local authorities will, of course, be adapting to their new responsibilities at a time when they are coping with significant reductions in resources.  As a result, concerns have been raised that local authorities could chose to divert spending from ‘core’ public health services to fund existing local authority activities when other budgets have been exhausted.  

While some in local government have perhaps coveted true decision making powers in health from afar, variations in outcomes could potentially become the defining feature of local authority health commissioning as some local authorities seize opportunities to test the boundaries and work in new ways while others choose to learn from example and take longer to get to grips with their new responsibilities.

Local authorities could play an invaluable role in integrating care and designing public health services to best meet the needs of their local community.  But if they are to fulfil their potential they need to be prepared.  Many have made good progress, but for others there is a long way to go.  Unless this is addressed by the Department of Health’s transition planning as well as the work of the Future Forum on public health and integration, there is a danger that progress in addressing public health priorities could be slow and patchy.

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Written by Paula Pohja   
Wednesday, 05 October 2011 14:54
Last Updated on Wednesday, 05 October 2011 13:56

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Dr Elaine McMahon CBE, Chief Executive and Principal, Hull College, Chair, Association of Colleges Sustainable Futures Group



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