Health and Social Care Bill

Memorandum submitted by City of London Corporation (HS 116)

General Background

1. The City of London Corporation provides local authority functions for the City. The square mile of the City of London has unique demographics with a residential population of some 9,000 but around 320,000 commuters arriving in the City every week day to work.

Specific issues raised by the Bill

2. Under the Bill the City Corporation will assume responsibilities for public health in the City. This will present a particular challenge for the City Corporation in that its obligations will extend to the 320,000 workers commuting into the City each day as well as the 9,000 residents. Clearly if the requirement under the Bill is "to improve the health of the people in its area" the City will need to deliver appropriate services to both residents and workers and thus the expectation in the Bill is that City's responsibilities will be greatly extended. The scope of such responsibilities, in relations to City workers, will go well beyond so called 'local workplace health initiatives'. Thus the funding arrangements under the Bill will need to recognise the City's increased obligations to a broader category of people.

3. The need to accommodate the City’s unique demographic is already recognised through its designation as a "special authority" in the Local Government Finance Act 1988 where special provision was made to take account of the City's unique circumstances. During the discussions leading up to the 1988 Act, the Department of Environment, the department responsible, recorded that special provision was needed "because the City has a very small resident adult population, .. which would constitute its tax base under the new system, but provides services for a daytime population of over a million. Its total expenditure is therefore exceptionally high in proportion to its resident population."

4. The position remains essentially unchanged quarter of a century later with the City’s local authority funding arrangements still separately calculated to reflect the fact that the City of London is a business district with a unique local business franchise and a small resident population.

5. The Bill’s measures should permit local flexibility to ensure that funding is available so that public health services can be commissioned that are appropriate for both workers and residents. The Liverpool Street Walk in Centre has collected anecdotal evidence which suggests that sexual health (in particular the morning after pill), is a key issue for City workers. It would make sense therefore for contraceptive services to be commissioned for both residents and workers. By way of further example, drug and alcohol issues are most likely to be recognised in the workplace (because of the impact on the ability to work) and those employees will, some evidence indicates, seek immediate help close to work. The proximity of such services close to the workplace also reduces disruption future treatment may cause to the working day. As a third example, it is very likely that, through the responsibilities created under the Bill, the City will have to actively tackle smoking among City workers. A recent study, commissioned by NHS City and Hackney to look at smoking prevalence amongst City workers revealed that 54% smoked which is significantly higher than the national average of 22%. In the City 37% smoke because of stress and 22% to help with keeping alert.

6. The Bill suggests that conditions may be applied limiting the use of the ring-fenced public health grant. To ensure that differing local needs can be fully met these should be widely drawn so as to allow local health provision to be as flexible as possible. A condition could, for example, stipulate ‘value for money’ but should not set out details of precise services that may be offered within the scope of the grant.

March 2011