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Paul Najsarek: Moving public health to NHS risks a narrower focus

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When Theresa May delivered her first speech as prime minister in July 2016 she made reducing health inequalities a top priority on her list of “burning injustices”.

Health and social care secretary Matt Hancock spoke likewise in July last year about prevention and how it can relieve pressure on healthcare systems while providing a better service to people.

Given this background, the overarching intent of the NHS long-term plan, published on Monday, is to be welcomed. All parts of local government, including the Society of Local Authority Chief Executives & Senior Managers, have signalled they stand ready to work constructively with the government, the NHS, and other partners to develop the plan and ultimately improve outcomes for everyone.

The plan focuses largely on the NHS, while acknowledging the importance of local government and health inequalities. By definition it can only take a limited view of the potential to improve public health.

The big prize in public health is the ability to address wider social determinants of health and reduce inequalities such as the one highlighted by Ms May almost three years ago: if you are born poor you will die on average nine years earlier than others.

With responsibilities over education, economic development, housing and social care – among others – local government is best placed to improve outcomes across the spectrum for communities.

The Commons’ health committee’s inquiry into public health in 2016 found the transfer of functions to local government to have been “largely positive”. Public Health England’s chief knowledge officer John Newton told the inquiry that 80% of 149 public health indicators showed they were either level or had improved since functions were transferred to councils in 2013.

This is despite the fact there will have been a £0.7bn real terms cut to public health funding from the government between 2014-15 and 2019-20.

In contrast to councils’ achievements the health committee concluded in 2009 that, under the NHS, health inequalities between social classes had widened over the course of the previous decade – by 4% amongst men, and by 11% amongst women.

In this context any suggestion that public health commissioning should change appears unsupported by evidence, and risks narrowing the focus of public health away from social determinants towards a narrower service focus.

This is not to say there is no role for the NHS in public health – far from it. With an ambition to roll out integrated care systems across the country, there is a big opportunity to develop and achieve a collective local ambition for improving the health of people in a place, tying in improvements to housing, education, and jobs alongside wider economic and cultural benefits.

On the eve of the tenth anniversary of the Marmot review, which identified local government as a pivotal partner in addressing the social determinants of health inequalities, now would be a good time for local government to confirm its ambition to reduce health inequality and work collaboratively with partners on the NHS plan ambition, while government commits to a broad vision for public health led by a properly resourced local government.

Paul Najsarek, community wellbeing spokesman, Society of Local Authority Chief Executives & Senior Managers community wellbeing spokesman, and chief executive, Ealing LBC

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