NW Directors of Public Health Master Class Friday 18 th February 2011 10 – 2pm

2. NW Directors of Public Health Master Class Friday 18th February 2011 10 – 2pm

3. NW Directors of Public HealthMaster Class Everything you wanted to know about local government but were afraid to ask…..

4. Trevor Hopkins Principal Consultant Local Government Improvement & Development

5. How big is local government? Total Local Government spend per year? £116 Billion Assets? £16 Billion How Many Councils in England? 375 (22 in Wales & 32 in Scotland) How Many Councillors? 18,500 How Many Employees? 2.3 million – LG is one of our largest employers People registered to vote in Local elections? 40 million

6. How is local government funded? Three main sources of income: Government Grants 54% - about £56 Billion in 2009 - 10 Council Tax 25% - about £25 Billion Redistributed Business Rate 19% - about £19.5 Billion Councils also receive income from returns on borrowing and investments, interest and capital receipts, sales, fees and charges and rents.

7. History More central control over funding, loss of local control over hospitals and municipal gas and electricity works Centralisation limits adaptive capacity of local government Between 1832 and 1875 the number of central government inspectorates increased from 0 to 20 Autonomy of local government Regularised the role of Loss of water services Loss of ancillary health services and sewers Wellbeing Powers Residual Poor Law functions transferred to local authorities Growth in local autonomy and size of central grants Privatisation gradually erodes accountability and local control 1834-5 1875 1888 1929 1948 1962 1972 1980 1997+ Poor Law Amendment Act and Municipal Corporations Act Local Government Act Local Government Act Local Government Act Local Government Act

8. The 21st Century – a new role? • Labour Government – partnership working, Local Area Agreements, Sustainable Community Strategies, Area Based Programmes, attempts to ‘close the gap’ especially in child poverty and health… …but top-down control, huge industry of inspection, performance targets, • Conservative/Liberal Democrat Coalition – have dismantled most of the previous administration’s structures. Wants: “a fundamental shift of power from Westminster to people”. Local councils, communities and neighbourhood schemes will be given more power to determine local issues by a “radical devolution of power”.

9. Legal Framework • Local Councils and their powers are enshrined in Primary Legislation • Central Government influences Local Government through - Guidance • Funding • Secondary • Regulations • By agreement • But it can’t just tell LAs to do something unless it has been given the powers to do so through legislation.

10. Different types of Councils

11. Types of Councils - What’s in a name ? Third Tier • Parish • Town • District • Borough • County • City • Metropolitan • Unitary • London Borough • City of London Corporation • Greater London Authority Second Tier Two Tier Top Tier Two Tier

12. Single Tier Unitary Councils Were created in 1990s when some Counties and Districts were abolished. Metropolitan Districts 36 Were created in large cities in partial reorganisation in 1986 when the Metropolitan Boroughs were abolished London Boroughs All 33 were created in 1965

13. Two-tier - County County Council • Initially 1888, reorganised in 1929, 1974,1996/8 and 2008 and 2009 District & Borough Councils • Initially 1894 reorganised in 1929, 1974 and late 1990s Greater London Authority • Created by the GLA Act of 1999 and formally established in 2000. The GLA Act of 2007 introduced additional and enhanced powers for the Mayor of London and the London Assembly

14. Two-tier - Regional Greater London Authority • In 2000 Mayor for London took on transport, some waste, environment and economic development responsibilities • 2006 added housing strategy, large scale strategic planning applications strengthened waste and climate change role.

15. What do they do? Council services Councils provide three types of service to their communities: • Statutory services – such as refuse collection – that councils must provide • Regulatory services – such as pub licensing – that councils must provide • Discretionary services – such as tourism that councils may choose to provide.

16. Typical Council Services • Education • Adult Social Care • Services for children & families • Safeguarding children and adults • Social housing • Roads, highways and transportation • Planning and regulatory services • Environmental services and health • Trading standards • Leisure, culture and sports • Libraries • Fire and rescue

17. How are decisions made? • Councils may be structured in three different ways: • A Leader and a Cabinet • Councillors elect a Leader who then appoints a Cabinet • An Executive Mayor and a Cabinet • Public vote for a Mayor who then appoints a Cabinet • A Council with a structure of Committees • In areas with populations below 85,000 Councils may adapt the older Committee model where no distinction is made between cabinet Members and backbenchers.

18. How do local elections work? • Councillors are elected for four-year terms. They are elected: • ‘All up’ • There is an election of the whole council every four years • ‘By thirds’ • One third of Councillors are elected once in every four years • But… • In seven District Councils they are elected by halves • An individual is eligible to stand as a candidate for the council if they are over 18 years of age, a citizen of Britain, the Commonwealth or European Union and meet certain criteria. • It is not possible to stand for election to the council if you work for that council or another council in a politically restricted post, are bankrupt or have been in prison recently

19. Current political balance and recent election results • The balance of power in local government changes frequently due to regular elections and by-elections. Following the May 2010 local elections, the political parties’ representation in England and Wales was as follows: • Conservatives – controlled 201 councils and had 9,265 councillors • Labour – controlled 51 councils and had 4,487 councillors • Liberal Democrats – controlled 25 councils and had 3,772 councillors • others’ – controlled 9 councils and had 1,965 councillors • There was no overall control in 87 councils. A council is described as having no overall control if one party rules as a minority or with coalition agreement.

20. Council Cabinet Other Committees Scrutiny Officers How does the council work? • Councillors decide policy & represent electorate • All sit on the ‘Full Council’ • Split into two roles (except in some cases) • Executive Councillors • Overview and Scrutiny Councillors • Officers are the paid employees, they are professional advisors and carry out the work.

21. Role of Elected Members

22. Different Types of Mayors Lord Mayors Elected Mayors Town Mayors Borough Mayors Mayor of London The Lord Mayor of London Council Chairmen/Chair

23. Problems and Opportunities – a council of all the talents? • Despite pockets of excellence overwhelmingly standard picture • Average age 58.3, 70.7% male (population 48%), ethnic minorities 4.1% (pop 9.5%), retired 35% (pop 22%) • Only 11% of Council Leaders women • 36% of all public appointments now women • Direction of travel not encouraging number of councillors under 25 halved 1997 - 2001

24. Local government is different • Administration and delivery must be achieved in a democratic context… • involving members • subject to politics and the electoral process • joint leadership has to be developed • requires active work by both Members and officers • Community leadership is about more than services, referenda and partnerships • Regulatory and standards bodies, statutory and strategic responsibilities www.idea.gov.uk

25. Code Of Local Government Conduct Local Authorities Standards Committees National Standards Board Conduct of Local Government Members & Employees

26. Local Government Association (LGA) Local Government Improvement & Development (LGI&D) Local Government Employers (LGE) Local Government Regulation (LGR) Local Government Leadership (LGL) The Local Government Group

27. The Business Plan sets out five priorities: Reputation – building and maintaining the national and local reputation of councils Innovation and value for money – supporting councils to achieve greater local efficiency and effectiveness Local democracy – ensuring that councils are at the forefront of greater local decision making on spending priorities and leading improvement work across the sector Economy – supporting councils to lead their communities to prosperity in the economic recovery Customer service – ensuring that the LG Group enhances the reputation of local government and delivers value for money The LG Group priorities for 2010 - 11

28. Local Government isdifferent. Whose culture is going to change the most – yours or theirs – and in what ways? The ring-fenced budget has the potential to marginalise public health in local government. How will you advise the council to use yours? My two challenges:

29. Presentations The opportunities and challenges of working in Local Government

30. A new definition of public health and a new set of priorities? Dr Mike Grady Senior Fellow, Marmot Review Team University College, London

31. Fairness at the heart of all policies. • Health inequalities result from social inequalities – requires action on all the social determinants; the causes of the causes • Focusing solely on the most disadvantaged will not reduce inequalities sufficiently – action is needed across the social distribution.

32. Life expectancy and disability-free life expectancy at birth by neighbourhood income deprivation, 1999-2003

33. Fair Society: Healthy Lives: 6 Policy Objectives • Give every child the best start in life • Enable all children, young people and adults to maximise their capabilities and have control over their lives • Create fair employment and good work for all • Ensure healthy standard of living for all • Create and develop healthy and sustainable places and communities • Strengthen the role and impact of ill health prevention

34. Per cent of children achieving a good level of development by local authority: England

35. Per cent not in education employment or training by local authority: England

37. My two challenges: How do you shift the agenda to focus on early intervention on the social determinants of health? How do you exercise political astuteness and strategic influence within the health and wellbeing board to secure your public health outcomes?

38. Working with politicians – the new strategic leaders for public health Councillor Jonathan Owen Deputy Leader East Riding of Yorkshire Unitary Council

39. ‘Dr Livingstone I presume?’

40. Opportunities • Closer to the Community • LA Resources • LA Freedoms • JSNA • Ring fenced budgets • Champion for the cause

41. Challenges • Who’s the Boss • Ring fenced budgets • Elected member whims • Scrutiny • Priorities

42. Challenges • Evidence • Politics • Timescale for outcomes • Academic pride • Two-tier Authorities

43. My two challenges: Elected Members champion community & people issues not the DPH. Politicians will want to manage the DPH not vice-versa – is this an issue?

44. A new culture with new relationships and accountabilities Robin Stonebridge Independent Consultant & PCT Non-executive Director

45. 15th September 2010

47. Health is core business for councils • local councils founded on health and social issues • then: big killers were infectious diseases • now: big killers are heart disease, cancer and respiratory disease • if councils are about improving ‘place’ then this needs to include health

48. Plato’s Cave and Public Health......

49. Where does the DPH sit?

50. Public Health challenges moving forward..... Does public health exhibit the attributes of a discrete profession or the characteristics of a social movement? Can we develop a shared vision for public health based on local priorities and needs , with milestones for which practitioners are prepared to be locally accountable?