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Councils say 'no' to public health ring-fence

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The government should think twice about ring-fencing public health budgets devolved to local authorities as part of its NHS reforms, councils have warned.

The Local Government Group response (see file at right) to the health white paper Equity and Excellence: Liberating the NHS, warns that such a move could be a barrier to achieving the best health improvement outcomes.

The LGG warned that councils could see the ring-fence as “the total resource with which to fund existing public health and health improvement activities” rather than as a contribution to work funded by mainstream budgets.

The stance could put councils on a collision course with health secretary Andrew Lansley, who favours ring-fenced – or protected – budgets for local areas.

While the LGG is upbeat about the potential to take a leading role in co-ordinating local health and social care services, it also recognises that the government’s proposed reforms risk fragmenting healthcare and public health improvement.

It said the creation of an NHS Commissioning Board and Public Health Service at national level, with GP consortia and councils at local level “could also result in commissioners and providers of health services no longer being seen as agents of public health improvement”.

Elsewhere in its response, the LGG said it believed the reorganisation should see councils given the lead in commissioning ‘Cinderella services’ such as: mental health; health and wellbeing of the homeless; drug and alcohol dependency; dementia; children and young people; learning-disabilities;  HIV and Aids; carers; older people; and free nursing care.

David Rogers (Lib Dem), left, who chairs the LGA’s Health and Wellbeing Board, said that the reorganisation had the potential to be hugely beneficial to local health services if it was handled properly.

“Councils need to be at the heart of commissioning, especially in the areas they have experience and expertise, like so-called ‘Cinderella services’ for the vulnerable,” he said.

“GPs are inexperienced here, and there’s a real risk they may not see the incentive of commissioning services where success isn’t easy to measure, or might outsource commissioning for these groups, breaking a vital link between an individual’s health and social care services.

“Decisions on where to spend money and commission services need to be taken locally.

“Councils know their residents’ needs best and using available funding as they see fit will keep people healthier and reduce the burden on the health service.”

He said that although much had changed since councils pioneered public health improvement in the 19th Century, councils were still best placed to drive further improvements.

The LGG response also calls for:

  • Councils to retain scrutiny powers over local health services in addition to the creation of Health and Wellbeing Boards
  • Urgent clarification of funding arrangements for patient and public involvement for March 2011 onwards
  • No compulsory staff transfers to councils from PCTs
  • Top level discussions over how to balance national and local priorities for public-health outcomes
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