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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.

Written by Paula Pohja
Wednesday, 05 October 2011 14:02

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David Wathey, Head of Sustainable Procurement, Department of Health

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  76. UPDATE `jos_session`
      SET `data` = '__default|a:7:{s:15:\"session.counter\";i:47;s:19:\"session.timer.start\";i:1330907045;s:18:\"session.timer.last\";i:1330913657;s:17:\"session.timer.now\";i:1330913665;s:22:\"session.client.browser\";s:89:\"Mozilla/5.0 (compatible; archive.org_bot +http://www.archive.org/details/archive.org_bot)\";s:8:\"registry\";O:9:\"JRegistry\":1:{s:7:\"\0*\0data\";O:8:\"stdClass\":0:{}}s:4:\"user\";O:5:\"JUser\":23:{s:9:\"\0*\0isRoot\";b:0;s:2:\"id\";i:0;s:4:\"name\";N;s:8:\"username\";N;s:5:\"email\";N;s:8:\"password\";N;s:14:\"password_clear\";s:0:\"\";s:8:\"usertype\";N;s:5:\"block\";N;s:9:\"sendEmail\";i:0;s:12:\"registerDate\";N;s:13:\"lastvisitDate\";N;s:10:\"activation\";N;s:6:\"params\";N;s:6:\"groups\";a:0:{}s:5:\"guest\";i:1;s:10:\"\0*\0_params\";O:9:\"JRegistry\":1:{s:7:\"\0*\0data\";O:8:\"stdClass\":0:{}}s:14:\"\0*\0_authGroups\";a:1:{i:0;i:1;}s:14:\"\0*\0_authLevels\";a:2:{i:0;i:1;i:1;i:1;}s:15:\"\0*\0_authActions\";N;s:12:\"\0*\0_errorMsg\";N;s:10:\"\0*\0_errors\";a:0:{}s:3:\"aid\";i:0;}}', `time` = 1330913665
      WHERE `session_id` = '7op7pud180fdav772gqv2ejns4'

33 Query Types Logged, Sorted by Occurrences.

SELECT Tables:
  1. 16 × select (b.id)id from jos_categories as a,jos_menu as b
  2. 8 × SELECT * FROM jos_categories
  3. 6 × select * from jos_content
  4. 6 × select (a.username)username,(a.email)email,(b.firstname)firstname,(b.lastname)lastname,(b.cb_org)cb_org,(b.cb_title)cb_title,(b.cb_jobtitle)cb_jobtitle,(b.avatar)avatar from jos_users as a,jos_comprofiler as b
  5. 5 × select * from jos_comprofiler
  6. 4 × SELECT extension_id AS "id", element AS "option", params, enabled FROM jos_extensions
  7. 2 × SELECT a.id as id,a.type as type,a.name as name,a.clickurl as clickurl,a.cid as cid,a.params as params,a.custombannercode as custombannercode,a.track_impressions as track_impressions,cl.track_impressions as client_track_impressions FROM jos_banners as a LEFT JOIN jos_banner_clients AS cl ON cl.id = a.cid LEFT JOIN jos_categories as cat ON a.catid = cat.id
  8. 2 × select id,title,catid,introtext,created_by from jos_content
  9. 1 × select * from jos_web_media
  10. 1 × SELECT m.id, m.title, m.module, m.position, m.content, m.showtitle, m.params, mm.menuid FROM jos_modules AS m LEFT JOIN jos_modules_menu AS mm ON mm.moduleid = m.id LEFT JOIN jos_extensions AS e ON e.element = m.module AND e.client_id = m.client_id
  11. 1 × SELECT * FROM jos_banners
  12. 1 × select * from jos_jcomments
  13. 1 × select * from jos_tag_term
  14. 1 × select * from jos_event_web as a inner join jos_web as b on b.id = a.webid
  15. 1 × SELECT id FROM jos_menu
  16. 1 × select (a.catid)catid,(b.level)level from jos_content as a, jos_categories as b
  17. 1 × select * from jos_web
  18. 1 × SELECT id, home, template, s.params FROM jos_template_styles as s LEFT JOIN jos_extensions as e ON e.element=s.template AND e.type='template' AND e.client_id=s.client_id
  19. 1 × SELECT * FROM jos_jcomments_setting
  20. 1 × SELECT m.id, m.menutype, m.title, m.alias, m.path AS route, m.link, m.type, m.level, m.language,m.browserNav, m.access, m.params, m.home, m.img, m.template_style_id, m.component_id, m.parent_id,e.element as component FROM jos_menu AS m LEFT JOIN jos_extensions AS e ON m.component_id = e.extension_id
  21. 1 × SELECT folder AS type, element AS name, params FROM jos_extensions
  22. 1 × SELECT * FROM jos_languages
  23. 1 × SELECT b.rules FROM jos_assets AS a LEFT JOIN jos_assets AS b ON b.lft <= a.lft AND b.rgt >= a.rgt
  24. 1 × SELECT * FROM `jos_jcomments_objects`
  25. 1 × SELECT count(*) FROM jos_jcomments AS c
  26. 1 × select * from jos_tag_term_content as a, jos_tag_term as b
  27. 1 × SELECT c.*,CASE WHEN CHAR_LENGTH(c.alias) THEN CONCAT_WS(":", c.id, c.alias) ELSE c.id END as slug FROM jos_categories as c LEFT JOIN jos_categories AS s ON (s.lft <= c.lft AND s.rgt >= c.rgt) OR (s.lft > c.lft AND s.rgt < c.rgt) LEFT JOIN (SELECT cat.id as id FROM jos_categories AS cat JOIN jos_categories AS parent ON cat.lft BETWEEN parent.lft AND parent.rgt
  28. 1 × SELECT a.id, a.asset_id, a.title, a.alias, a.title_alias, a.introtext, a.fulltext, CASE WHEN badcats.id is null THEN a.state ELSE 0 END AS state, a.mask, a.catid, a.created, a.created_by, a.created_by_alias, a.modified, a.modified_by, a.checked_out, a.checked_out_time, a.publish_up, a.publish_down, a.images, a.urls, a.attribs, a.version, a.parentid, a.ordering, a.metakey, a.metadesc, a.access, a.hits, a.metadata, a.featured, a.language, a.xreference,c.title AS category_title, c.alias AS category_alias, c.access AS category_access,u.name AS author,contact.id as contactid,parent.title as parent_title, parent.id as parent_id, parent.path as parent_route, parent.alias as parent_alias,ROUND( v.rating_sum / v.rating_count ) AS rating, v.rating_count as rating_count FROM jos_content AS a LEFT JOIN jos_categories AS c on c.id = a.catid LEFT JOIN jos_users AS u on u.id = a.created_by LEFT JOIN jos_contact_details AS contact on contact.user_id = a.created_by LEFT JOIN jos_categories as parent ON parent.id = c.parent_id LEFT JOIN jos_content_rating AS v ON a.id = v.content_id LEFT OUTER JOIN (SELECT cat.id as id FROM jos_categories AS cat JOIN jos_categories AS parent ON cat.lft BETWEEN parent.lft AND parent.rgt
  29. 1 × SELECT `data` FROM `jos_session`
OTHER Tables:
  1. 3 × UPDATE jos_banners SET impmade = (impmade + 1)
  2. 1 × UPDATE `jos_session` SET `data` = '__default|a:7:{s:15:\"session.counter\";i:47;s:19:\"session.timer.start\";i:1330907045;s:18:\"session.timer.last\";i:1330913657;s:17:\"session.timer.now\";i:1330913665;s:22:\"session.client.browser\";s:89:\"Mozilla/5.0 (compatible; archive.org_bot +http://www.archive.org/details/archive.org_bot)\";s:8:\"registry\";O:9:\"JRegistry\":1:{s:7:\"\0*\0data\";O:8:\"stdClass\":0:{}}s:4:\"user\";O:5:\"JUser\":23:{s:9:\"\0*\0isRoot\";b:0;s:2:\"id\";i:0;s:4:\"name\";N;s:8:\"username\";N;s:5:\"email\";N;s:8:\"password\";N;s:14:\"password_clear\";s:0:\"\";s:8:\"usertype\";N;s:5:\"block\";N;s:9:\"sendEmail\";i:0;s:12:\"registerDate\";N;s:13:\"lastvisitDate\";N;s:10:\"activation\";N;s:6:\"params\";N;s:6:\"groups\";a:0:{}s:5:\"guest\";i:1;s:10:\"\0*\0_params\";O:9:\"JRegistry\":1:{s:7:\"\0*\0data\";O:8:\"stdClass\":0:{}}s:14:\"\0*\0_authGroups\";a:1:{i:0;i:1;}s:14:\"\0*\0_authLevels\";a:2:{i:0;i:1;i:1;i:1;}s:15:\"\0*\0_authActions\";N;s:12:\"\0*\0_errorMsg\";N;s:10:\"\0*\0_errors\";a:0:{}s:3:\"aid\";i:0;}}', `time` = 1330913665
  3. 1 × UPDATE jos_content SET hits = hits + 1
  4. 1 × DELETE FROM `jos_session`