The Health Devolution Commission has delivered a very clear answer to the question that should have been the subject of much discussion, but wasn't, during the General Election. Following an online stakeholder survey during June, the Commission's July meeting has concluded that to strengthen Integrated Care Systems (ICSs) the new Labour Government should prioritise:
· reducing health inequalities and improving the health of the population
· involving directly people with a lived experience of care in service specification and delivery
· the health of babies, children and young people
· shifting NHS resources towards community, primary care, prevention and early intervention
Perhaps the most far-reaching proposal is for the new Government to turn the Labour Party's ambition for England to become a ‘Marmot' nation into an across Government mission.
The hard-hitting report makes 12 recommendations to Government including three specifically affecting local government:
· Local government should be given a multi-year funding settlement for both its public health services and its wider role in tackling the local social determinants of ill-health that reverses the major decline in public health and council funding over the last decade.
· Integrated Care Boards must show how there is a genuine power sharing relationship between the NHS and the local government partners in their area.
· Every combined authority and/or metro mayor should have a statutory public health improvement duty similar to those for London, Greater Manchester and the West Midlands to ensure that regional economic growth is inclusive and supports better health outcomes.
Perhaps the most far-reaching proposal is for the new Government to turn the Labour Party's ambition for England to become a ‘Marmot' nation into an across Government mission. This would ensure clear and accountable leadership for reducing health inequalities, improving the public's health and maximising the role of health and social care as the engine room of inclusive economic growth.
The Commission proposes there should be a cabinet-level Mission Delivery Board for health equity established to agree a timetable with milestones in order to deliver the ‘Marmot' mission. This would be chaired by the deputy prime minister and be the cross-government mechanism to address the social determinants of ill health as well as delivering public health services.
The Commission believes we are at a pivotal moment for our health and social care system in which resources can and should be re-directed towards the key priorities of reducing health inequalities, improving the health of the population and addressing the social determinants of ill-health. This is not just a moment for the UK but is a global opportunity as key players in multinational settings such as the G20 are now putting health equity at the centre of their thinking.
The Commission believes that now is the time to go further. For example it welcomes the new health secretary's statement recognising the health and care sector's role as engines of economic growth and local and regional anchor institutions and proposes the Government should support ICSs to use their autonomy to develop policies, strategies and actions that maximise the contribution the NHS, social care, public health and other publicly funded services can make to being an engine of inclusive local economic growth.
The Commission acknowledges improving the performance of NHS and social care services is critical for the new Government. But it argues improving health outcomes is not just about clinical interventions or even changing people's lifestyles but is, more importantly, about addressing the wider social determinants of poor health (low incomes etc) and the quality of the local environment and places in which people live.
It suggests the purpose of the Government's target of greater economic growth must be to deliver ‘good work' and the funding for the public services that enable better health and wellbeing. In the words of Professor Marmot: the overarching goal of social, economic and environmental policy is to ‘create the conditions for people to live the lives that they have a reason to value'.
Moving the Government to a health in all policies approach would represent a sea-change in the machinery of Government. Change at the top should be mirrored by action by ICSs who the Commission propose should receive specific financial incentives for them to focus on reducing health inequalities and improving population health; and to shifting resources towards community-based health, social care and public health services.
Other long overdue changes recommended include ICSs being mandated to involve directly people with a lived experience of care in service specification and delivery; to create meaningful partnerships with the VCSFE sector; and to ensure genuine power-sharing between the NHS and local government. It also proposes every ICS should consider adopting the Child Health Equity Framework principles and there is a national cross-departmental Child Health Equity strategy.
The report concludes the Government should not substantially re-organise ICSs but this is the time to strengthen the structures and mutual accountability of both Integrated Care Boards and Partnerships as well as the place-based partnerships and the primary/community care networks. It should also take steps to re-direct resources towards statutory and voluntary sector health, social care and public services. Moving decisively now to making England a Marmot nation would bring all these actions into focus and create momentum for lasting change.
The report is available at https://healthdevolution.org.uk
Phil Hope and Steve Barwick are the Secretariat of the Health Devolution Commission
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