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Tough calls for councils in the public health challenge

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Does the transfer of responsibility for public health to councils represent a significant opportunity for local government to do more to improve the health and wellbeing of local communities? If so, what do councils and their partners need to do to ensure this opportunity is exploited?

The public health challenges facing the country were cogently set out in the Marmot Review. Locally some communities face particularly pressing problems and many local authority areas encompass stark health inequalities. In many respects the council wheel has turned full circle.

Local government’s roots lie in responding to the public health challenges of the late 19th and early 20th centuries. Today’s equivalents – ranging from childhood obesity to sexually transmitted diseases – increasingly dominate local priorities.

There is a strong case against simply “lifting and shifting” the public health function from PCTs to local councils

Yet the jury is out on just how significant the transfer of responsibility for public health to local government and the creation of Health and Wellbeing Boards are. Some people see the public health transition and the new boards as a chance to restore local government’s role at the heart of the public health role with potentially significant gains for local communities.

Others question the extent to which these arrangements will have real traction in relation to the old NHS beasts in the form of the acute sector and the new beasts in GP commissioners. They etect powerful centralising tendencies in, for example, Public Health England.

Questions to be explored include whether there is a shared understanding of what public health means today and what the relevant levers and policy instruments are. Also important is the question of how local councils need to change to enhance the effectiveness of the public health role.

There is a strong case against simply “lifting and shifting” the public health function from PCTs to local councils, but what are the building blocks of an alternative approach? How should the local public health function relate to other features of the changing health landscape, including Public Health England, mental health trusts, the acute sector and the new commissioning arrangements?

Lord Crisp’s recent call for more hospitals to close is a useful and important contribution to the debate. As the former NHS chief executive he knows only too well that there is overcapacity in the hospital sector and that closing some would free up funds for community services.

The challenge was a leadership one – to make the positive case for closing hospitals. An important question for councils and their partners is whether Health and Wellbeing Boards will have the leadership and courage to make this case.

Phil Swann, programme director, Shared Intelligence

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