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Cash fears cloud public health reaction

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Local government has praised the government’s public health proposals in principle but has called for much greater clarity on how the sector’s bolstered role will work in practice.

The Local Government Association said the proposals in Healthy Lives, Healthy People represented a “great opportunity to build on the good work which already exists across the country”, while the Association of Directors of Adult Social Services (ADASS) said the sector was “up for” the challenge.

Nevertheless, both organisations have underlying fears about the tranfser of public health functions back to councils.

The white paper, unveiled on Tuesday, repeatedly restates the government’s vision of devolving health improvement work from the NHS to local government, under the oversight of directors of public health and their support teams.

Health secretary Andrew Lansley’s plan will see upper-tier and unitary councils given ring-fenced public-health budgets in shadow form from 2012-13 and in practice from 2013-14.

But the proposals contain little detail on funding levels, or responsibility, other than identifying some £4bn in current public health spending.

That funding will be overseen by new Department of Health body Public Health England, to be created from the merger of  the Health Protection Agency and the National Treatment Agency for Substance Misuse.

Out of the assumed £4bn, it will fund public health research and national programmes before devolving funding and “health-premium” success payments to councils. Even then a substantial chunk of the money given to local government could be identified for “non-discretionary” public health spending.

ADASS president Richard Jones said that while it was right that health improvement sat with local government, there was a need for ministers to identify exactly how much funding would be made available locally – details which will be on hold until after a yet-to-be launched funding consultation.

“We need to see a level of clarity concerning what resources will be held nationally and which locally,” he said.

“We’d like to see as much devolved locally as possible, and we definitely support the notion of a health premium to incentivise delivery of locally agreed targets.”

David Rogers (Lib Dem), chair of the LGA’s community wellbeing board, echoed those concerns and questioned the actual freedom councils would have to deliver health improvement.

“This white paper states it is time to free up local government and local communities to decide how best to improve the health and wellbeing of their citizens, but it doesn’t go far enough and leaves many questions unanswered,” he said.

“Behind the language of greater freedom lies a swing to central control which risks hampering town hall efforts to boost health.

“With Public Health England employing the majority of the public health workforce, how can we make sure local and national needs work hand in hand? How can we answer to government when the people leading on public health don’t answer to us? Public Health Directors must be accountable to councils.”

The Department of Health insisted that directors of public health would be accountable to councils as part of their health and wellbeing board duties.

Frank Atherton, president of the Association of Directors of Public Health, said he wasn’t surprised to see no details on the government’s funding proposals, but was relieved to see ministers had retained their promise to protect public health funding.

“I’m pleased that we have clarity that the ring-fence is going to be there in the short term and make it less likely that local authorities will raid the public-health budget,” he said.

He said that the potential for key public health staff to be lost during the transfer from PCTs to councils was a “significant worry” but that it ought to be possible for local authorities and Primary Care Trusts to work through staff-transfer issues even without clearer funding details.

Nigel Edwards, acting chief executive of the NHS Confederation, said the implementation of the proposals would be the ultimate decider of whether they did more harm than good.

“We need to work out the details about what incentives there will be to encourage each part of the system to work together and also how to ensure clear accountability,” he said.

“It may be sensible to mandate that GPs sit on local council health and wellbeing boards or keep some public health expertise inside the NHS.

“Without greater clarity on these issues, the risk is that the reforms will flounder.”

Shadow health secretary John Healey said Mr Lansley’s white paper fell far short of the health secretary’s “own hype” and would “disappoint the many people passionately passionately committed to better public health”.

“I welcome in principle lead responsibility for improving public health being passed to local government but it must have the powers and the funding to do the job properly,” he said.

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