Select Committee on Health Written Evidence


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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