Health and Social Care Bill: the increasing role for local government within health?

The Health and Social Care Bill was published yesterday. Clearly there is a lot of controversy over what some might see as “another top down reorganisation” as well as specific issues around tariff variability, competition policy, more private providers and potential for existing hospitals to be allowed to fail. This posting is not about that as other blogs such as the independent King’s Fund and the more critical Paul Corrigan are covering those issues in much more detail.

What I want to look at is where there does seem to be at least some political consensus. That is the enhanced role of local government within the local health economy.

Key responsibilities for Local Councils will include:

  • There will be a legal requirement to create Health and Well-being boards and a duty on the GP consortia, directors of public health, adult social services and children’s services, as well as the local HealthWatch, to participate. Indeed, some Councils like my own in Sutton, have already established a shadow Health and Well-being Board.
  • Health Overview and Scrutiny Committees will not now be abolished and indeed there will be an extension of formal council scrutiny to cover all NHS-funded services.
  • The Public Health Service will be run at the local level by Councils with a ring-fenced budget and local priorities determined by the Health and Well-being Board.
  • Local authorities will fund the work of local HealthWatch organisations and will contract support to help them carry out their work. Local authorities will have a legal duty to ensure that the activities and support for local HealthWatch organisations are effective and value for money. In the event of under-performance, the local authority will be able to intervene and, if necessary re-tender the contract to support the work of HealthWatch. Local authorities will also have to ensure that the focus of local HealthWatch activities is representative of the local community.

This is a significant advance for the role of local government, which along with their new Power of General Competence to do anything not prohibited by law, gives local authorities a significant incentive to take a more powerful role in local health provision at a time when resources in the area are declining less than local government core funding.

In the past it has been said that health professionals would object to local government interference, However from research we have conducted with GPs in various areas, we detect the exact opposite and many of those most active in pathfinder GP consortia are looking forward to greater collaboration.

Apart form the formal structural role outlined above, local authorities may want to seize the opportunity to both support and contribute to greater commissioning for preventative health. As many as one in three hospital beds are occupied by people with diabetes, asthma and emphysema who were admitted as emergency patients. This was a point made recently by NHS Chief Executive, David Nicholson. He recently said:

“Their care has not been properly managed in the community. The trend towards emergency admissions will be reversed. Better management of these patients can restrict significantly the number of emergency admissions, for the benefit of the patients and the NHS as a whole, enabling you to reduce your bed stock in acute hospitals…The NHS is devising a comprehensive mechanism to enable them to better manage their own care.”

The question is can this be delivered by GPs who are also commissioners? This sounds like something where local authorities working in partnership with voluntary and private sectors could be commissioned to deliver a stronger “preventative service”, which also includes building on currently developing re-ablement strategies.

In view of the budgetary measures, this could also be a relatively non-contentious area to develop Big Society approaches as this would be all about a new service that reflects modern trends in health care. This could include a mix of local authority led enablers and trainers along with trained volunteers or front line staff to pop round to people or phone them to see how they were doing and give them the advice and support they needed on self-care.

Often people end up in A&E for a complex range of emotional as well as physical reasons, sometimes because their personal and local social networks and social capital is poor. Mapping the community to understand not just its physical needs but also its psychological needs, emotions, motivations and values is important too in order to prioritise limited resources. This could then lead to targeted interventions; following up regularly on the most vulnerable with the right form of communication, contact and support.

There could be all sorts of models commissioned by GP consortia through forthcoming pilots, including a buddy model, even radical ones utilising Police community support officers in a dual function?

Much of the debate on the Bill so far has been about commissioning a range of acute and community curative services. This is of course likely to dominate the health debate at Westminster in the coming months. In the meantime local authorities will start looking as to how they can join-up their social care activity with health to make a preventative offer for GP consortia to commission that adds to the other health roles they will be developing.

Charlie Mansell is the Research and Development Officer at The Campaign Company. I would like to thank my colleague Nick Pecorelli for some helpful comments that contributed to the development of this posting. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.

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