Councils should not try to block health reform

As the NHS celebrates it's 65th birthday there is a big shift taking place away from general hospitals towards specialist hospitals. Local council's don't run the NHS. But councils do have an interest in what it does, where it does it and how well it does it.

If there is a proposal for a hospital to stop doing something and for it to be done by another hospital then the local council will be expected to have an opinion on the matter. The danger is that councillors will be swayed more by politics than by clinical evidence.

On my own patch there is Charing Cross Hospital which is being rebuilt and the services it offers changing. Some have suggested that as the existing building will be demolished that means the hospital will cease to exist. But it is a phased rebuilding. The existing tower block at the hospital is in poor condition. £90m has been agreed for a new state of the art hospital on the existing site. At no stage during the building process will the hospital close. To say we will "lose the hospital" is like saying you would "lose your car" if you trade in a Skoda for a Rolls Royce.

At least 85% of patients at the hospital would continue to be treated there. However they would still allow for greater specialisation, which the NHS tells us would save 130 lives a year. At the moment the mortality rate is much higher for patients admitted at weekends than week days - as they are more likely to see junior doctors rather than consultants.

The Government must go much further on public service reform

Cllr Philippa Roe, the Leader of Westminster City Council, says more local incentives and innovation is needed

The government has done much in recent years to drive forward public service reform across areas such as education, welfare and health. Good Conservative local government is also doing its bit as regular readers of these pages will know including my own council and its Tri-borough partners where we have driven through savings, streamlined processes, joined up services and introduced early intervention schemes so that we can deliver better, more efficient and more responsive services to the people we serve.

Local government is also influencing the national reform agenda. The Budget, for instance, highlighted evidence from the Whole Place community budget pilots that will help shape some of the key principles of the spending round - smarter ways of delivering better outcomes for less, putting local knowledge at the heart of Whitehall decision making; and far more emphasis on joint working across the local public sector.

This work at the local level is also being increasingly acknowledged by those in Whitehall. Greg Clark recently wrote here how central government could learn lessons from the reforming zeal of Conservative town halls.

Ten ways for councils to tackle health inequality

During the Labour Government between 1997 and 2010 health inequality widened. The life expectancy gap between rich and poor increased by 7% for men and 14% for women. The good news is that life expectancy increased for everyone, but it was much faster for the rich than the poor.

Around £4 billion a year has been spent on public health (of which £2.5 billion a year will now be given to councils). But it has been largely wasted. Lots of generalised nanny state messages about giving up smoking, losing weight, using condoms, etc. An army of people going round with clipboards and balloons engaging with people and monitoring their ethnic group. Another army inputting data.  Lots of stakeholders, projects, strategies, advisory assessments, cessation co-ordinators, pathways. All top-sliced, front-loaded, fast-tracked, and multi-disciplinary.

Nothing very tangible achieved.

As mentioned, average life expectancy has increased - from 74 for men and 79 for women to 78 and 82 respectively. But this is largely because we have got richer. It's thanks to all those thrusting wealth creating capitalists. The worthy public health bureaucrats appear to have been an irrelevance if the widening gap between rich and poor is anything to go by.

Westminster Council proposes docking benefits from the fat

An interesting report from Westminster City Council and the Local Government Information Unit is published this morning. The report reflects the transfer of responsibility for public health from the NHS to local councils.

It says:

Several local authorities have introduced schemes that allow GPs to prescribe physical activities at local facilities including council swimming pools, gyms, yoga and walking clubs.

However the council does not need to own the swimming pool or gym. Public health would be better served with these facilities thriving under the ownership of private enterprise rather than being constrained as part of the municipal empire. Not that ownership would make much odds to the type of voucher scheme described as being made available.

Councils should be rewarded for health screening role

Glyn Gaskarth says councils should be paid by results for preventive health work

The Local Government Information Unit in cooperation with Westminster City Council has released Payment by results: The perfect storm of public sector finances. This think piece includes policy options for councils in the areas of health and welfare. This blog explores the suggested policy proposals in preventive health where councils have been given a new role by our coalition government.

Britain spent almost £100 billion on health care in 2010. This will increase as Britain’s population ages and becomes increasingly overweight. Two thirds of Britons are overweight and one quarter is obese. The proportion that is overweight is predicted to increase by 10 per cent over the next ten years. Around one fifth of the current UK population will reach age 100. Why is this problematic? We are living longer and eating too much. These are good problems to have but unfortunately it will lead to an increase in cases of dementia, diabetes and heart disease.

Dementia costs the UK an estimated £23 billion of which £10 billion relates to health and social care costs. Every individual with the ailment costs the economy an estimated £27,000 per annum. Dementia risk factors include high blood pressure, high cholesterol, diabetes, smoking and heavy alcohol use.

Diabetes costs are estimated at 10 per cent of NHS expenditure. Around nine in ten diabetes sufferers have type 2 diabetes. Risk factors include being overweight, having a sedentary lifestyle and eating an unbalanced diet. Overweight individuals are twelve times more likely to contract this ailment. The NHS spends around £9 billion per annum treating this condition. If left undetected it can cause blindness, heart disease and strokes.

Councils charged with improving public health

The Government's Public Health White Paper is to confirm that responsibility for public health will be switched from the NHS to local councils.

Apparently the money will be ring fenced. This is a mistake. If councils can show they are able to deliiver more for less in this area, as elsewhere, they should be encouraged to do so. The test should be such factors as reducing the number of pregnant women who smoke, or reducing childhood obesity or increasing the number of new mothers who breast feed or increasing the number of pensioners who take flu jabs. Etc, etc, etc. The test should not be making sure the full budget is spent without any savings being found.

But it is still an encouraging localist initiative for this function to be transferred to councils. In terms of joined up Government it is also a good fit.

As Health Secretary Andrew Lansley says:

 "Health is not just about the quality of healthcare. It's probably at least as much about the quality of people's lives - the environment, the housing, their education and employment."

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. 

Give councils control of health budget

Glyn Gaskarth says localising the health service would give councils an incentive to improve adult social care

The budget asked Local Authorities to cut their budgets by a quarter over the next four years. In contrast, the £100 billion plus national health budget will be protected and increased. Perversely this means cuts in the £6 billon social care budget controlled by local authorities. Social care can (in some cases) save the health service money by keeping the elderly healthy and reducing the need for costly medical treatment. We must end this false separation between health and social care.

The coalition agreement offered the Conservatives an opportunity to reassess their pledge to increase health spending. The Liberal Democrats did not promise to increase health expenditure over the Parliament or ring fence health expenditure from cuts. However, the Conservatives have retained their NHS spending pledge. Mr Cameron defined his political philosophy in three letters NHS. He means to honour that commitment.

Magna Carta for localism: Better care

The CPS paper proposes that while the NHS should be the focus for medical treatment, all non-medical personal care should become the remit for local councils.

The report says:

The efforts of the PCT and the local council often overlap. Given that many of the people who receive social care services also receive local health services, combining these budgets into a single pot would provide an opportunity to reduce cost and improve service delivery. A range of professionals from GPs to health visitors to environmental health officers interact with residents to provide services that can improve long-term health.

The says the proposed change would rng the following benefits to care services:

Residents would have a single entry-point for their health and social care needs. This would take the form of a single assessment to determine eligibility. This type of model should enable earlier intervention and result in better case management.

Pooling budgets across services that deliver public health benefits will enable local authorities to innovate. For example, investing more resources into improving poor quality housing or getting people back into work would improve health outcomes in the longer term. Pooling personal budgets across health and social care can be an incredibly powerful tool for preventative action.

Wirral Council overcharging the vulnerable and shooting the messenger

 Wirral Council, a Labour/Lib Dem coalition led by Cllr Steve Foulkes, a Labour councillor. They seem to adopt the same approach as Haringey towards whistle blowers who expose failings in caring for vulnerable residents.

Martin Morton, a council officer in Wirral, found that the Council was massively overcharging vulnerable residents, most of whom could not read or write. But rather than sort out the problem the Council tried to shut him up.

Private Eye's Rotten Boroughs column includes an item on it in their current issue:

A 10-year campaign by a whistleblower who uncovered serious overcharging of vulnerable people by Wirral Council's adult social services has ended with the authority admitting it should repay almost £250,000 in excess charges.

Sixteen people were found to have been overcharged up to £100 a week by social services under the supported living scheme, in which people are helped to live in their own homes.

The item concludes:

And has Morton received a herogram - or at least an apology? ot exactly. For continuing to insist on exposing the truth he was, he claims, bullied, driven out of his job and at one point hospitalised with stress. In 2008 he received a payoff of £45,000 and was asked to sign a gagging clause. Happily, he has chosen to ignore it.