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Public health to be devolved to councils

The Health Secretary Andrew Lansley includes in the NHS White Paper plans to abolish the Primary Care Trusts. Most of their budgets would be to GPs but the element for promoting public health will go to the local councils.

The White Paper says:

PCT responsibilities for local health improvement will transfer to local authorities, who will employ the Director of Public Health jointly appointed with the Public Health Service. The Department will create a ring-fenced public health budget and, within this, local Directors of Public Health will be responsible for health improvement funds allocated according to relative population health need. The allocation formula for those funds will include a new “health premium” designed to promote action to improve population-wide health and reduce health inequalities.

This is good news. However I'm not sure the ring fencing is sensible. Councils should be judged by output of what health improvements they can achieve rather than the input of what they spend. If they can do an effective job for less than the current spending level then they should be able to cut the Council Tax.

They haven't worked out what slice of the PCT budget goes on health promotion and will thus be handed over to Town Halls. But it will be a lots of money. I've mentioned before that in my borough there are eight people employed by the NHS to go around with clipboards asking people to sign up to stop smoking and then ring them ask to ask how they are getting on. No doubt we have another team of anti smoking officers monitoring the anti smoking officers out on the "front line." That stuff about "health inequalities" provide a further distraction from practical work. "Can we ring back the people who have given up smoking and ask their sexual orientation, socio economic group, etc, etc..."

Doubt it does much good. I suspect those who give up smoking would have done so anyway. It would be better giving everybody in our borough who wanted one a free flu jab. Or employing more school nurses. Or doing something that could make a real difference for a targeted group to give up smoking. Free hypnosis for pregnant women for instance. 

The ring fencing also restricts how the money is spent. Money should be able to shift across from one budget to another. Improving health care might be done through imrpoving poor quality housing stock. 

What if a Council wanted to use the money to spend more on the subsidy for school meals? Or funding schools to have their own kitchens? They might regard that as more effective way of promoting healthy eating and tackling childhood obesity than employing an army of Childhood Obesity Performance Monitoring Co-ordinators.

The White Paper also says:

The Secretary of State, through the Public Health Service, will set local authorities national objectives for improving population health outcomes. It will be for local authorities to determine how best to secure those objectives, including by commissioning services from providers of NHS care.

In which case don't mess us around ring fencing the budget.

There is always some sham localism in the White Paper. Lots of stuff about telling the NHS they have to "consult" local councils - then the NHS can just carry on and do what it likes anyway. This placebo accountability could just provide greater bureaucracy and delay. For instance we have:

Giving local authorities new functions to increase the local democratic legitimacy in relation to the local strategies for NHS commissioning, and support integration and partnership working across social care, the NHS and public health;

Or this:

Local Involvement Networks (LINks) will become the local HealthWatch, creating a strong local infrastructure, and we will enhance the role of local authorities in promoting choice and complaints advocacy, through the HealthWatch arrangements they commission.


One area where I am unclear from the White Paper is whether the Magna Carta for localism proposals will be implemented regarding health care. Will all non-medical personal care should become the remit for local councils rather than the current messy overlap? Will residents would have a single entry-point for their health and social care needs with a single assessment to determine eligibility?





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