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Councils really will be pivotal to public health

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I was pleased to read the recent Local Government Chronicle focus on the Health and Social Care Bill because the articles put some challenges to the department.

For example, how would ministerial powers balance with proposed greater flexibility for local authorities? Will second-tier authorities be left out in the cold in the new system? How will the central agenda influence local public health?

I want to take this opportunity to respond to some of these issues and to explain how through the new health and wellbeing boards, and their new responsibilities in respect of public health, local authorities will play a pivotal role in local peoples’ health and wellbeing.

The Health and Social Care Bill provides local authorities with an important public health role. For me, the challenge will be for local government to seize the opportunity to improve the health of local people, to develop their local leadership role for health and wellbeing.

We will support local authorities in their role with a new ring-fenced public health grant, but crucially, we will leave many of the most important decisions to local authorities. The main line of accountability will be to their local populations, not the government. 

Concerns have been raised about national, versus local, accountabilities. The Secretary of state for health will take the responsibility for key national components of the public health system by establishing Public Health England within the Department of Health. The Bill also gives him the lead role in protecting health. That’s as it should be – protecting the nation from threats like disease and radiation is on a par with protecting national security, and belongs at the heart of government. But this does not take away local authorities’ significant existing responsibilities in that area.

The new system is being designed to be more streamlined and responsive. Consolidating national leadership in Public Health England and local leadership in local authorities will integrate public health into national and local decision making beyond the traditional confines of the health and social care sector.

This is a challenging agenda but also a fantastic opportunity. It’s because of the significant new powers the bill sets out for local authorities that last month I wrote to all local authorities, inviting them to join a network of early implementers of health and wellbeing boards.

I believe health and wellbeing boards give us the opportunity to do all the things we’ve long wanted to – to improve the health care and well being of local people. This won’t happen unless we get the right people around the table, making genuinely local decisions. This is not about mechanistically setting up board meetings. It is about developing collaborative leadership –changing the culture and behaviours within the system, building capacity and capability for local leaders to respond to current and future challenges.

I want to call on you to get involved now. There are big challenges ahead and the change agenda cannot be delivered from Whitehall. That’s why we have made a gearshift, moving from a nationally driven approach, weighed down with guidelines and directives, to a genuinely collaborative way of working.

The early implementer network has been designed in partnership with 25 councils, with their partners, to help all local authorities establish health and wellbeing boards and learn from the experience of the early implementer network. Early Implementers will develop their approaches with local partners, other local areas, share experiences and learn from each other. It makes real our ambition to develop the necessary shared leadership and common purpose for national and local leaders. This approach has not characterised the way we have traditionally worked, but I’m clear we will only succeed together.

The network isn’t just made of up people already working in local government – emerging GP consortia, directors of public health, emergent HealthWatch and voluntary sector organisations are also getting involved now.  We also recognise the vital role of second tier authorities. We know they have lots of experience and expertise to offer. Health and wellbeing boards are a forum to engage them and ensure their key role in driving local health improvement is retained and encouraged. There is a consensus that joint working and integration can, and will, make a difference to local communities.

By engaging now, local authorities will be able to work through the big challenges collectively, building new collaborative leadership relationships and making a success of new accountabilities, with the energy and input of the network providing vital momentum.

Our commitment to the network is to provide national leadership and coordination and support working with colleagues in Local Government Group and strategic health authorities.

We will help the network create opportunities to exchange learning and ensure that Early Implementers create the capacity and capability to ensure all local authorities are ready to take this important responsibility forward by 2013.

We will produce learning products for instance on the new Joint Strategic Needs Assessment, and help other parts of the health and care economy to understand local government’s role, including the importance of political leadership.

The network will also provide the forum to discover and build on good practice – we have already heard about exciting progress made in areas including Greater Manchester, Oxfordshire, Leicestershire and Hull, who have all developed new relationships to benefit local people.

Let’s keep focused on the purpose. When asking early implementers why they signed-up they told us “it’s going to give us the best chance of making a difference, as soon as possible, that’s what we’re all working towards.” The prize, the vision we share, is improving the health, care and wellbeing of people in our local communities, putting them at the centre of all we do. The strategic leadership of local government is what will make that happen.

David Behan, director general of social care, Local Government and Care Partnerships at the Department of Health

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