By Paula Pohja, Hannah Cornick, Ben Nunn and Greg Penlington.
The Government’s health reforms involve a significant increase in responsibility for local authorities, which 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 retain a role in scrutinising health service delivery to this day. Yet the scale of responsibility is a step change and the ease with which local authorities assume their responsibilities will be a significant determinant of the extent to which the reforms achieve their aims of ensuring decisions are made closer to patients, the interests of patients are put before those of organisational boundaries and the critical importance of public health is recognised and prioritised.
In order to assess the preparedness of local authorities for these new responsibilities, MHP Health Mandate has undertaken the first ever comprehensive audit of local authorities. 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, others have some way to go.
Our research found that:
- Understanding of public health is mixed, with 43% of local authorities having no definition of the term, despite the fact that they will soon be responsible for commissioning public health services through a ring-fenced budget
- Links with primary care trusts are patchy, with nearly a third (29%) of local authorities unable to confirm they had communication with their local Primary Care Trust regarding public health services within the last year, despite the fact that integration will be a key task for local authorities
- Despite the fact that 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 to inform the development of a board in their area
However, there are also many examples of good practice which could be spread:
- Just over half (52%) of local authorities are already involved in commissioning and delivering public health services, receiving funding from PCTs to do so. Common themes for co-funding include action to tackle substance misuse (54%), obesity (34%) and sexual health (26%)
- Most local authorities (75%) report that they share a joint director of public health with their local PCT
- Half of local authorities reported discussing public health issues with other local authorities within the last 12 months
- The majority (82%) of local authorities identified tackling rising levels of obesity as a priority in their Joint Strategic Needs Assessment (JSNA) and set out recommendations for addressing the issue, with over half (56%) containing action plans to address childhood obesity
Ready for health? is intended to help inform local authorities’ planning, the Department of Health’s transition planning as well as the work of the Future Forum on public health and integration. It makes 12 recommendations intended to support effective implementation of the spirit of the reform proposals.
Anyone seeking to influence public health commissioning, efforts to integrate services or support the work of local health and wellbeing boards in scrutinising the plans of clinical commissioning groups, will need to understand the variations in the preparedness and priorities of local authorities. This report provides the first insight into the nature and extent of these variations. Please do not hesitate to contact us at firstname.lastname@example.org if you would like to discuss the findings of the report further.