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Public Health Transition to Local Government: Latest Policy Developments

Public Health Transition to Local Government: Latest Policy Developments. David Hunter Professor of Health Policy & Management 29 th January 2013. School of Medicine Pharmacy & Health. What’s been happening?.

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Public Health Transition to Local Government: Latest Policy Developments

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  1. Public Health Transition to Local Government: Latest Policy Developments David Hunter Professor of Health Policy & Management 29thJanuary 2013 School of Medicine Pharmacy & Health

  2. What’s been happening? • Oral evidence sessions – House of Communities and Local Government Committee Inquiry: The Role of Local Authorities in Health Issues • Prospects for Health and Wellbeing Boards – The Smith Institute report • Delayed announcement on ring-fenced PH funding for LAs, 2013-14 and 2014-15 School of Medicine Pharmacy & Health

  3. Select Committee Inquiry – Key Messages (1) • Not a full return (or transfer) of public health function to local government – significant chunks of activity lie at the centre with NHSCB and PHE, including over half the available funding • Ring-fenced funding will be absorbed by mandated services (sex, drugs and alcohol services, school nursing) leaving little flexibility over other public health priorities • Risk of wider public health being ‘crowded out’ by: • Public health ‘offer’ to NHS • NHS and healthcare agenda • Integrated care School of Medicine Pharmacy & Health

  4. Key Messages (2) • Lack of confidence in local government to use levers at its disposal to improve health • Role and accountability of DPH uncertain in some LAs: to be at the top table or not to be? • DPH role is to be an influencer • New complex relationships to be managed effectively, including: • Department of Health and Department for CLG • DH and PHE • PHE and NHSCB (at national, regional and local levels) • PHE and LAs (critical friend or performance manager or regulator) • CCGs and HWBs • NHSCB and HWBs • Two tier LAs School of Medicine Pharmacy & Health

  5. Key Messages (3) • Key role for place-based budgeting (remember Total Place Pilots?): from ring-fencing to place-based budgeting • Poor performance is a risk of localism • Who holds LAs to account: • Health scrutiny • Healthwatch • Concerns about HWBs, including • Size, frequency of meetings, governance • Role • commissioners of services? • focus on health and social care interface? • Great deal depends on nature of partnerships and relationships • Few powers: quality of leadership and relationships School of Medicine Pharmacy & Health

  6. Key Messages (4) • PHE to provide a spine on which quality and outcomes can be driven • New arrangements lack firmness and stiffness of spine necessary to drive forward measurable change at population level • Some arrangements 'pink and fluffy' • Localism versus top-down direction • Fears of loss of analytical capacity to CSUs • Less emphasis on lifestyles and more on root causes of ill health and barriers to lifestyle change • LA is a place-maker • Integration of public health into LAs - not a stand-alone department • HWBs are like orchestras - not everybody plays at the same time • Lobbying role for LAs to government, eg obesity and role of food manufacturers  • Timeframe to make a difference - 2015 School of Medicine Pharmacy & Health

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