The stuttering progress of the Health Bill too easily distracts from the huge impact it will have on local government behaviour and reputation. Two challenges will be critical to success.
Public health needs transformation so that its results can match its long held ambitions. That means embedding principles throughout council activity, from business support to housing, and then leveraging local partnerships so that all local public services encourage healthier living.
Bringing GPs and councils together through joint commissioning using population health strategies can open the door to health improvements that have eluded the NHS. Chronic care takes 70% of hospital beds, 50% of GP time and almost all social care budgets.
Better health is the key to financial survival for both NHS and local government. The NHS is cutting £20 billion and chasing 4% efficiency savings. Adult care lost £1 billion last year and needs 3.5% efficiencies from now on.
Health & Well Being Boards are the forum in which local government will be seen to succeed; or fail. Yet the benefits of localising are threatened by the very forces that make reform so urgent. For as the NHS comes under pressure its instinct is to centralise.
Public health funding plans arrived late and in vary wildly; in London from £20 to £122 per head. This is a symptom of a health system that thinks top down at the expense of innovation.
Likewise “commissioning support” where huge financial pressure has led to centralisation. CSOs reduce GP autonomy. CCGs will only have £25 per head to spend. Yet London Councils’ research showed that pooling council and CCG resources could double that figure to £50.
NHS DNA programmes it to face danger with centralisation. Even so the financial threats are huge we cannot call time out to make a better plan.
Instead we should develop local options that integrate commissioning and embed public health. Plans need visible support from GPs. Where these conflict with national policy we must argue collectively that local innovation best drives health reform.
Better healthcare needs our sector’s skill at integration and partnership. Local government’s reputation will be shaped by how well we do.
Dick Sorabji, corporate director policy & public affairs, London Councils