Memorandum by the Local Government Association
(WP 29)
INTRODUCTION
The Local Government Association (LGA) was formed
on 1 April 1997 and represents the local authorities of England
and Wales—a total of just under 500 authorities. These local
authorities represent over 50 million people and spend around
£78 billion pounds per annum. Our members include 34 county
councils, 36 metropolitan district councils, 47 English unitary
authorities, 32 of 33 London authorities, 238 shire district councils
and 22 Welsh unitary authorities. The LGA also represents fire
authorities, police authorities, national park authorities and
passenger transport authorities.
The LGA exists to promote better local government.
We work with and for our member authorities to realise a shared
vision of local government that enables local people to shape
a distinctive and better future for their locality and its communities.
The LGA aims to put local councils at the heart of the drive to
improve public services and to work with government to ensure
that the policy, legislative and financial context in which they
operate, supports that objective.
Local government has a powerful role to play
in promoting public health, not only because its diverse services
have a major impact on people's lives, or that it is one of the
largest employers in this country, but also because in its community
leadership role enshrined in the Local Government Act 2000 it
can work together with partners through LSPs to make a real difference
to local communities' health and well-being. Local Authorities
have also been using the powers of the Health and Social Act 2001
to scrutinise the operation of health services as well as wider
public health issues in their area. This relatively new role is
augmented by the fact that local authorities have a democratic
legitimacy that no other public organisation has at the local
level.
In response to the Choosing Health? consultation,
the NHS Confederation, the UKPHA and the LGA, produced a visionary
public health report called Releasing the Potential for the
Public's Health, which lists 16 recommendations for the Government
to act upon—a copy of the report is attached.
In addition, local government has shown its
pro-active commitment to the public health agenda as demonstrated
by the Shared Priority for Promoting Healthier Communities
and Reducing Health Inequalities. The 12 Shared Priority pathfinders
committed to the project are in the process of planning innovative
solutions to local public health problems in partnership with
the local NHS and key agencies at the national level. Further
details on this project can be found at the IDeA Knowledge website
(http://www.idea-knowledge.gov.uk/idk/core/page.do?pageId=77237).
WHETHER THE
PROPOSALS WILL
ENABLE THE
GOVERNMENT TO
ACHIEVE ITS
PUBLIC HEALTH
GOALS
The LGA overall welcomes the White Paper (WP)
and appreciates the extra funding, new initiatives and long-term
commitments that the Government has made. However, it is clear
that achieving the WP's goals will depend on work carried out
by local authorities, Primary Care Trusts and their partners at
the local level. It is therefore absolutely vital that local authorities
and their partners are properly reimbursed for their work (as
alluded to in the New Burden's doctrine in the WP). Local authorities
will be responsible for implementing many elements of the WP including
amongst many other things, tackling under age tobacco sales, extending
physical activity and leisure services, expanding the number of
extended schools and enforcing any legislation on smoking in public
places.
The LGA is also pleased that the Government
will ensure all its policies are health impact proofed. In our
"Releasing the Potential" report we urged the Government
to ensure that all its policies and programmes of all Departments
of State are subject to a process of health impact assessments
and inequality "proofing". The LGA is therefore glad
that the Government has taken on board this recommendation, but
we would go one stage further. Along with partner organisations
the NHS Confederation and UK Public Health Association, we believe
that the Government should establish a new Public Health Minister
of cabinet rank with cross-government responsibility for promoting
public health and reducing health inequalities. We believe this
would demonstrate the Government's commitment to tackling health
inequalities and ensure that there is effective national leadership
and coordination of public health action. We also called for the
transfer of public health responsibilities out of the Department
of Health. The three organisations are of the opinion that retention
of public health responsibilities by the DH obscures the cross-cutting
nature of the issue and reinforces the erroneous view that the
NHS alone can promote and sustain good health.
It is these radical changes at the centre that
would have created the leadership and publicity to drive the agenda
and help meet the WP's goals. As it currently stands, there seems
to be a myriad of different individuals and groups working on
the WP and little clarity as to how they will be co-ordinated.
The LGA would be happy to be involved in a co-ordination function
along with other key national stakeholders.
One of the most controversial elements of the
White Paper is the proposal to ban smoking in public places. But
this is one of the key policy areas that, with concerted action,
could significantly affect public health and reduce health inequalities
in this country. Although the LGA supports the staged approached
to banning smoking in public places outlined in the WP, the Association
has concerns about how the proposed smoking ban in public places
will be implemented and the long timescale proposed. The WP does
not outline exactly how the smoking ban will be enforced, particularly
with regard to the licensing of bars and pubs and how smoking
will be prohibited in "bar areas". The LGA would like
the Government as soon as possible to clarify its intentions in
this area, including how it will fund any extra financial burden
placed on local councils. The Association is concerned about the
effect the partial ban on smoking in pubs will have in terms of
encouraging pubs to stop serving food, particularly in more deprived
neighbourhoods. The LGA is also not aware of any research which
shows that complete smoking bans would encourage more people to
smoke at home. In all these areas, more evidence-based research
is needed.
Finally, the LGA has reservations about the
long-term effectiveness of voluntary agreements with the food
industry to reduce fat, salt and sugar levels in foods or to work
with the food industry and advertisers on food promotion to children
and other vulnerable groups. Time will tell whether these kinds
of agreements will work, but the Government must be prepared to
use legislation or regulation if necessary as a last resort. The
Association believes that the Government should be prepared to
take urgent, precautionary action to strengthen the regulatory
framework affecting the public's health, placing the onus of proof
on industry and not the public, and establish an independent,
stakeholder-driven process to adjudicate the evidence.
WHETHER THE
PROPOSALS ARE
APPROPRIATE, WHETHER
THEY WILL
BE EFFECTIVE
AND WHETHER
THEY REPRESENT
VALUE FOR
MONEY
The LGA endorses many of the new initiatives
proposed in the White Paper:
— Extension of the Healthy Schools
Programme;
— Healthy Start Programme for families;
— Pilots for promoting health in the
workplace;
— Further investment in physical activity;
— The new funding for PCTs to tackle
health inequalities; and
— The advent of NHS accredited health
trainers and Health Direct, amongst others.
At this stage it is difficult to say whether
the proposals outlined in the WP will be effective and represent
value for money. Much will depend on the content and aims of the
Delivery and Action Plans as well as whether the timetable for
consultation, legislation and other policy developments are prioritised
and delivered to schedule. It is also clear that the whole programme
is regularly and independently evaluated to ensure progress is
being made. Much of this will initially focus on outputs but in
the medium to long-term the evaluation must focus on how outcomes
from the programme is reducing health inequalities and improving
the public's health.
WHETHER THE
NECESSARY PUBLIC
HEALTH INFRASTRUCTURE
AND MECHANISMS
EXIST TO
ENSURE THAT
PROPOSALS WILL
BE IMPLEMENTED
AND GOALS
ACHIEVED
The LGA recognises that this agenda must be
addressed in partnership between local government, the NHS, the
voluntary and private sectors, as well as the communities themselves.
Local Strategic Partnerships are an important vehicle for bringing
partners together at the local level and there are some excellent
examples of Health Partnerships around the country. Successful
LSPs are often determined by how much different partners are prepared
to invest them in terms of resources and labour. They often work
best when there is a specific funding stream (such as the Neighbourhood
Renewal Fund) that binds partners to a common agenda.
In this respect, the advent and pilot of Local
Area Agreements is welcome. Under LAAs, local authorities, the
NHS and other relevant partners will be able to negotiate with
central government clear targets and outcomes for their areas,
but will have the autonomy and flexibility to decide locally how
best to achieve them. This new form of national/local agreement
will also simplify funding streams into one pot and act as a strong
inducement to joined-up working, particularly for PCTs. If proved
to be successful, the LGA would like to see LAAs and other similar
mechanisms mainstreamed so that they become the norm, not the
exception.
The Association also applauds greater integration
between the NHS and local government. Integration can be achieved
through more joint appointments (esp. Directors of Public Health),
joint teams and pooling together of expertise and resources (S31
agreements) as well Care Trusts, LAAs and strengthened LSPs. In
this respect, it is critical that each area decides its own approach
to integration. There is no standard blueprint that fits every
locality. An added benefit of greater integration is that it can
help overcome the different cultures, protocols and structures
(linguistic, social and financial) that can sometimes divide the
NHS and local government.
A further way the infrastructure for promoting
public health could be improved would be by realigning the boundaries
of PCTs and local authorities so that they are co-terminous. Co-terminosity
is particularly an issue in two tier authorities, where one county
might have to deal with four or more PCTs. Whilst we recognise
that this is not an essential pre-requisite for joint working—it
would nevertheless make it much easier for PCTs to set up joint
teams or posts, or plan and commission services together.
The capacity of PCTs to act on public health
needs to be enhanced as budgets for public health are often limited.
This is often compounded by the fact that they are judged by waiting
list targets and acute care—not public health or prevention.
The White Paper indicates that funding for PCTs in this area will
be substantially increased, especially in the more deprived areas.
This needs to be mainstreamed to all PCTs as soon as possible.
An underlying concern the LGA had about the
White Paper was the over emphasis it placed on the NHS. Clearly
this agenda can only be effectively addressed when all the key
stakeholders are prioritising public health and working together
to a common agenda. This very much reflects the views of the LGA
and its partners in the "Releasing the Potential" document.
CONCLUSION
Public health is as high on the agenda as it
has ever been. The Government and other key stakeholders now have
a great opportunity to make changes that will have an impact for
generations to come. There is no doubt that there is a groundswell
of interest and commitment from Local Government, the NHS and
others to promote public health and to tackle health inequalities.
The LGA believes that the White Paper offers strategic direction
but must be seen as a first step along the path towards a healthier
and less divided nation. After all, the White Paper's success
can only really be judged when health inequalities have significantly
declined in this country.
January 2005
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