When Matt Hancock gave his first speech as health and social care secretary, he said improving outcomes for patients is not just about improving healthcare in hospitals. It’s about keeping people out of hospital in the first place.
This has also been the view of districts for some time now. As prevention authorities, we can play a key role in helping Mr Hancock achieve his vision. As planning and housing authorities, districts have a vital contribution to make providing preventative services including housing, leisure and environmental health.
There is a clear and evidence-based case for strategic health partnerships to acknowledge the role of these services as part of their local health care ecosystems, improving public health outcomes and reducing demand for social care and acute health services.
Latest figures compiled in the District Councils’ Network’s Transformation in Localities Toolkit show district-led health prevention collaboration generates staggering returns. Districts prevented or relieved more than 66,000 homelessness cases – nearly a third of England’s total – which could save the NHS £85m annually.
Parks provide £34bn of health and wellbeing benefits, saving the NHS £111m a year through prevented GP visits. Furthermore, every £1 spent on home adaptions provides a saving of £7.50, with the same level of investment reaping more than £2 in care savings and quality of life gains to the NHS, as well as £108 over 10 years in prevented falls.
The DCN recently launched the Transformation in Localities Toolkit. This, shows how districts can make a prevention offer to health partners based on the importance of early intervention, accounting for wider determinants of health, such as housing and community safety; smoking, alcohol and substance use; diet and exercise; food safety; and air quality. We can also work on interventions which reduce delayed transfers of care.
For example, South Norfolk, Breckland, Broadland, North Norfolk DCs and Norwich City Council placed home improvement agency officers and housing options officers at a local hospital to help speed up discharge. To date the initiative has supported 184 patients, undertaken 290 interventions, cutting 725 bed days over 29 weeks, saving £181,250 and reducing recipients’ average length of stay by 36%.
Using the better care fund, Sevenoaks DC placed an adviser in GP surgeries to whom GPs identified their 25 most persistent patients. In most cases these were those experiencing mental ill health, loneliness, depression and debt issues, for whom the council could arrange community solutions to their problems.
With their housing and planning powers, districts can ensure existing and new homes promote health and wellbeing, and physical and healthier lifestyle are promoted through well-built environments, including green spaces and cycle paths. Following concerns about high levels of mental distress being presented in the new village of Cambourne, attributed to a lack of amenities, South Cambridgeshire DC stipulated planning applications for major developments must submit a statement showing how the proposal’s impact on health has been addressed.
And, by increasing uptake of physical activity by residents, my own council in Chiltern, together with partners South Bucks DC, estimates it is saving local healthcare services more than £65,000, and yielding a further £365,000 in wider health benefits such as quality-adjusted life years.
Districts can support the principles that are likely to underpin the forthcoming social care green paper, not least through district-led integrated care models and whole system approaches to public health, and by providing better support for families and carers by working with GPs and other partners on social prescribing to tackle loneliness.
Thus it is a major concern that districts are largely absent from place-based strategic discussions around health. This must change.
Our review of all 44 sustainability and transformation plans shows districts are named partners in only two cases. Realigning NHS-focused goals with the local focus and priorities of districts, which are on the front line of community support, will help districts expand their vital role in public health and prevention, helping even more people lead healthier lives for longer.
We have also called for districts to be allowed to levy a 3% “prevention precept” on council tax – similar to the social care precept available to councils which deliver social care. This could raise £42m a year in 2019-20 and significant long-term savings many times that amount for the NHS and social care authorities.
We also urge the government to consider establishing a health prevention fund which districts, alongside other councils and public bodies, can bid for to support projects that deliver preventative services and can reduce the financial burden on adult social care.
So when Mr Hancock reflects on how he can make the “serious progress” on prevention that he demanded in his speech, he should not overlook the important role districts can play, in reducing demand for health and social care services, and improving people’s lives.
Isobel Darby (Con), member lead for quality of life, District Councils’ Network; leader, Chiltern DC