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The secret to good health: good (local) governance

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LGC’s essential daily briefing

“Today, the poor are enjoying the health of where the affluent were 20 years ago,” said Duncan Selbie, chief executive of Public Health England at the District Councils’ Network conference last week.

Despite a doubling in spending on the NHS and a tripling in expenditure for doctors, the health gap between the rich and the poor has stayed static. You are still more likely to enjoy good, long-lasting health if you are rich than if you are poor, according to the UK’s public health stats.

And the secret to the UK’s future health statistically lies, according to Mr Selbie, with you: the readers of this very briefing, as he said public health could most easily be improved through direct intervention from local government.

In 2010 30,000 deaths occurred in the UK every year due to winter conditions, while Scandinavian countries registered close to zero. Professor John Ashton, also speaking at DCN, said this was partly due to two-tier tariffs on domestic fuel bills while Mr Selbie argued the problem was due to the quality of housing itself.

Good housing and jobs remain the most important areas for one’s personal wellbeing. They are also two areas that councils can have some direct controld over.

“I want councils to intervene to change the demands on public services as a whole,” Mr Selbie said.

According to Mark Lloyd, chief executive of the Local Government Association, that change is coming as the LGA’s number one lobbying priority in 2018 is “tackling the housing crisis”. Mr Lloyd echoed the housing and communities secretary’s advice that councils should “spend all of the extra money for housing and then spend some more” - the rationale being that the Treasury will free up even more money once it witnesses a return on investment and sees houses are being built.

If councils are to start building the “huge surge” in homes that Mr Selbie described, they will have to build fast. Historically, quickly built houses have been of poor quality and that will ultimately impact on the nation’s future public health; future NHS budgets will change according to the quality of today’s housing.

And according to Mr Lloyd, councils are already under immense stress to deliver, as 78,000 families with 128,000 children have registered as homeless with their councils in the past six years. The price of housing has tripled while rough sleeping has risen 169% since 2010. Labour reports that overall debt is now on average £14,000 per household and rising.

To this end, councils can either work harder than ever - or smarter.

The new minister for local government Rishi Sunak said that digital services have a “vital role to play” and councils should “harness technology to improve the quality and efficiency of services”. Providing more for less will therefore mean more technology and more collaboration.

As a result the chair of the NHS Confederation Stephen Dorrell said councils and local health bodies are “natural, unavoidable partners” and will have to work together more in the face of an ageing population.

He said local government stood “on the cusp of revolution” over its involvement in public health, and that involvement should increase in the near future as local leaders are invited to more clinical commissiong group and public health meetings.

“There is no definition of local government that doesn’t include health,” Mr Dorrell said. “If you say it is part of your agenda to be a part [of it] - who is going to argue.”

The future could be healthy but local government will have to play a pioneering role in improving access to quality housing and employment if that is to take hold.

By Rob Cusack, reporter


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