Local government is in one sense all about public health and always has been. What else are we aiming for in an outcome-based world if not to create places where people are both mentally and physically healthy?
Public health defines itself as ‘the science and art of promoting and protecting health and wellbeing, preventing ill-health and prolonging life through the organised efforts of society'.
The list of contributions from local authorities both before and after the transfer back to the NHS in 1974 to achieving this aim is impressive: sanitation, street cleaning, the introduction of child health visits, to name a few.
Councils have long been recognised in their public health role but this does not mean the 2013 transfer into local authorities has been simple.
We may all have been focused on a shared goal of creating healthy and thriving communities but ‘public health’ also meant the transfer of a distinct discipline with a new set of responsibilities, a different organisational culture and staff who had to adapt quickly to a new political environment. It has been a complex and rewarding journey.
At the time of the transfer I was the corporate director for community, health and wellbeing at Harrow LBC and was responsible for working on the public health transition plan. One of the biggest things that worried me was the loss of knowledgeable and passionate staff, who were concerned about the transition.
As always, our job is to retain the right people who can deliver for our residents and supporting people through change is part of that. Once this hurdle was behind us, making the transition a success and an important focus in ensuring public health operates as a strategic responsibility for shaping place and outcomes, rather than a technical team delivering services, was essential.
Five years later, in the role of chief executive at a different authority, I am proud of how the sector has worked together as commissioners and specialists to better understand the causes of population issues such as obesity and drug and alcohol addiction and to become better place-makers to effect change.
In Ealing, I am particularly proud of pioneering the Lets Go Southall physical activity programme in partnership with the local community and Sport England, which aims to address the underlying causes of inactivity.
The programme is designed to make the most of the public health evidence base and knowledge as well as joining up with departments such as housing and social services.
In 2012, Harrow also established a successful shared public health service between Harrow and Barnet LBCs. It is fair to say local authorities have given public health better expertise and frameworks with which to procure and monitor contracts, which has hopefully resulted in better value for money and in the commissioning of public health services.
There has been some brilliant work across the country, over the last five years. To pick out a few from the Local Government Association’s report, Public health transformation five years on:
l–The Southwark plan for land and spatial use has placed a high priority on active travel and air quality. It also addresses all the social determinants of health – setting high standards for the protection of and access to green space and new housing and emphasises the development and sustainability of a strong local economy with good access to employment and training opportunities.
l–Dudley Public Health is actively involved in designing and supporting a multi-speciality community provider (MCP) – based on improving population health, prevention and reducing the demand on health and care service. The MCP operates to an outcomes framework in which prevention is incentivised by a gradual shift in emphasis through the course of a 15-year contract period. Sexual health, substance misuse and integrated wellness service will all be delivered through the MCP under a Section 75 pooled budget arrangement.
l–As part of the whole-system health and care transformation programmes East Sussex Better Together and Connecting For You, East Sussex CC developed a system-wide asset-based approach to prevention and early intervention with a view to making sustainable change at scale and pace. This involved extensive community engagement and partner organisations from the health, care, voluntary and other sectors. Multi-agency delivery groups, locality networks and locality link workers are all part of the infrastructure underpinning the programme of work developed from this approach.
All this was achieved while both public health budgets were reducing and councils were being forced to make significant savings across other services.
I don’t imagine the next five years will be any easier. The public health grant ringfence removal, Brexit, the retention of business rates and continued austerity measures will make it even more important we have the right structure and leadership in place across our organisations to continue to deliver on public health priorities. If there is one thing which will help us to effect long-term change for our communities, it is continuing the move towards a more place-based approach, where there is prioritisation of spend and activity across all partners – including health, police and skills. In the short-term, I do not think there is a need to rush to put in place new controls once the ringfence is removed.
Councils care about public health services and outcomes, so we should start from a position of trust in their ability to prioritise and deliver them. Much better would be a shared positive ambition for our communities.
The challenge for us as leaders is to continue to open the door for public health to use its best tools, research and evidence to create compelling visions which help us to urge policy-makers, politicians and public servants alike to see the value in long-term investment to address the social and environmental determinants of health.
To that aim, a more positive response to the ringfence removal would be a concordat about councils’ ongoing commitment to tackling the determinants of ill-health as well as a recognition that public health services and knowledge will continue to play an important part in that.
I think councils have and can continue to deliver on public health outcomes – with the right funding. We know our communities – their weakness and opportunities. We have already started to engage with the public in a different way and we have always been about creating happy, healthy communities. Five years on, I think the integration has been a success, but we now need to quicken the pace and scale of successful interventions and keep long-term wellbeing for residents at the heart of what we do.
Paul Najsarek is wellbeing spokesman for the Society of Local Authority Chief Executives (SOLACE) and chief executive of Ealing LBC