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A health role that we should relish

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Health care reform is about to put councillors centre stage; nowhere more so than in London. The Health and Social Care Bill brings new duties and a new role to local government.

Councils face three challenges; to transfer public health to local government, support GPs in their Clinical Commissioning Groups and to set up Health & Well-being Boards.

Health care is changing. A generation ago the challenge was still in the operating theatre; talented surgeons pulling people back from the brink. Today chronic care is the big issue including conditions like stroke, diabetes, or mental health.

1.3 million Londoners have a chronic condition. 65% of outpatient appointments are for chronic conditions. Over 70% of hospital beds are for patients with chronic conditions. London Councils research shows that £5bn a year is spent on chronic care in London. Yet unlike acute care, the spending is spread across both the NHS and social services.

The evidence is clear that joining up care and giving patients more say keeps people healthier and does so at less cost. That is why councils and GPs need to develop a new joint approach to better health care.

Local government will have the duty to lead this process, but we cannot succeed by replacing one top down approach with another. Local government skills in engagement and creating partnership will be vital to meet the three challenges we face.

Firstly councils need to create a local public health function that works better because it connects with all other local public services. Bringing in public health to local government also allows us to develop deep understanding of the health needs for the local population. That knowledge must support commissioning by both GPs and councils.

The second task is to support better care commissioning. This means looking for every chance to integrate the analysis, contract management, public engagement and back office support systems that the CCGs and London boroughs will need. By doing this we can better shape health care delivery to meet patient needs.

Lastly, local government needs to bring these decisions together in Health & Well Being Boards. This partnership depends on trust. Councillors and GPs need to develop a shared vision for health care, win public support and speak confidently for their communities when they engage with government and national quangos.

Dick Sorabji, corporate director, policy and public affairs, London Councils

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