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A missed opportunity for an action plan

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The Marmot Review on health inequalities emphasised councils’ central role but many in local government were left frustrated by the lack of detail.

Professor Sir Michael Marmot’s findings have been criticised as failing to shine a clear enough light on what the sector should actually do to address society’s imbalances.

Fair Society, Healthy Lives proposes six key areas for work, of which more pump-priming for early years’ initiatives is the priority, but it falls short on solid proposals for immediate action.

It does call for “greater emphasis” on the “pivotal role” councils have in delivering health improvement. But there is little on how this should progress and no action plan, despite examples of good practice, such as Liverpool’s Healthy Homes Programme (right).

Prof Sir Michael also calls for better monitoring of results and sharing of the evidence of success from local government initiatives, as well as the introduction of national targets on life expectancy and health inequality, including a new benchmark for measuring the proportion of households that have an income considered “sufficient” for healthy living.

Amelia Walker, who leads the Local Government Information Unit’s Centre for Service Transformation, says the report essentially paints an already understood picture of what is wrong without any useful next steps.

But she says councils could take some empowering messages from the report. “The really useful thing for local government is that it very clearly says that health inequalities are … about things that local government is responsible for.

“The big message for local government, which doesn’t come across clearly, is to see that if we want to have better health in the hope of having less expensive health services, you need to move more money into prevention.”

Ms Walker argues that at a time when billions of pounds need to be saved, there is a good case for redirecting health prevention funding away from the Department of Health and paying it directly to councils, on Total Place principles.

Barnsley MBC chief executive Phil Coppard, who was involved in an early phase of the review process, agrees that a funding bias towards the NHS is a problem.

“Most of what needs to be done isn’t within the remit of the NHS, and that is a fundamental flaw of the way that health inequalities are approached,” he says.

Alyson Morley, senior policy consultant at the Local Government Association, describes the report as a “missed opportunity”.

“The whole point of health inequalities is to try and get down the business case for co-operative public spending,” she says.

James Hulme, head of communications at the New Local Government Network says the report has failed to adequately highlight the constraints local authorities face in exercising influence over health spending.

“The vast majority of decisions are made by unelected primary care trusts and we would like to see a clearer role for democratically elected and accountable local government,” he says.

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