As the UK moves to having four distinctive health care systems as a result of devolution, the role of local councillors in relation to health matters becomes less uniform. For example, unlike Wales, where health and local government bodies have been coterminous since 1974, England remains a patchwork quilt of overlapping health and local government bodies which is made worse by the ever increasing privatisation of both health and local authority services.
This short article captures some common issues about which councillors across the UK might want to think. Topics covered include: scrutiny and public consultations, shaping integrated systems, and public health.
Scrutiny and Public Consultations
In all four administrations local government can play a key role in holding the NHS to account, both by standing arrangements for Scrutiny and by taking a leading role in testing any proposals for service change which the NHS might put forward. The machinery for doing this varies – especially in England where market –style arrangements are increasingly used to govern the relationship between “commissioning” and “providing” functions and where the public health function is now placed firmly in the local authority domain.
In England the Health Scrutiny Regulations 2013 are intended to give local areas flexibility and freedom to shape the scrutiny role of Health and Well being Boards as best fits local circumstances – including the option to establish topic – specific sub committees.
Scrutiny
Local authority scrutiny of selected health activities – based firmly on its democratic mandate for local leadership – should be built into the annual scrutiny programme. The regulations stress that local authorities are able to scrutinise three aspects: how health care services are planned, how they are provided, and how they are operated locally. Local circumstances will shape some of the topics but councillors might want to might include at least one area of scrutiny work from each of the following categories.
- The robustness of local arrangements between primary, social care and secondary care aimed at preventing crisis referrals (and inappropriate admission) to acute hospitals
- How well linked are health and local government planning functions for agreeing “need” and “demand” for the decade ahead in all parts of the Council’s area (down to ward level) – and the crafting of shared responses to such need.
- How continuity of health care is ensured for looked after children leaving care.
- How well local providers perform across a range of performance measures – including clinical performance and managerial / financial performance.
Public consultations
It seems inevitable that the NHS will continue to undertake public consultations on service change as austerity bites and increased attention is paid to existing service defects. Local councillors have a key role in all public consultations. They can:
- Ensure key community interests are alerted as soon as news of impending consultations is known
- Work hard, at an early stage, to try to shape the nature and language of the proposals so that the issues are written about in a way that ordinary people can see through what is proposed.
- Ensure that the “Gunning principles” on consultation are followed – for example, is it clear what the issue is about upon which views are sought; has sufficient information been provided; can it be seen that the decision makers are taking all comments seriously?
- Use council resources (officer time to probe papers, meeting rooms for pubic sessions, generate publicity etc) to alert the public to the issues being raised and to provide informed arenas to which health officials can come and have their proposals examined.
Shaping integrated care systems
Too often local councillors take little notice of what officers of health and local authorities are doing when it comes to trying to improve the co-ordination or integration of care offered by them both. Whether in the care of elderly, younger disabled, or mentally ill people, or in distinct services such as those relating to substance misuse and eating disorders, interest in, and leadership of, the better integration of services is sometimes lacking at elected member level.
Yet there are key issues upon which elected members could make a difference. For example, is the Council an outward looking one that sets the pace for its key partners, or does it shy away from partnership work? Does it put the protection of its budgets first or is it willing to experiment with joint funding and pooled budget methods? What about joint appointments of senior staff, with the freedom to switch or blend local authority and health cash and craft teams of people from both bodies? How well do information systems support the planning of locally relevant services, or report on their delivery of care? How often does the full Council debate such matters in public meetings?
Public Health
The public health function brings powerful tools to an understanding of health issues – whether this sits within local government as in England, or within the NHS.
Wherever it is located organisationally, elected councillors should take an interest in its work across a number of dimensions. Some of these are briefly described below.
Health Status Reporting
The production of useful and intelligible data on the health status of complete local authority areas, and smaller areas within them, should be a routine task of the public health function – and should be used regularly by Local Authorities. Housing, education and environmental health tasks of local government all play a part in ensuring good and improving levels of public health. Economic data should also feature as there is some evidence that health status and differentials in income in localities are linked.
Mortality and morbidity data
Local councils should have an understanding of what are the main killers are in its area, and what are the main causes of major illness that impact adversely on the quality of life. While the major causes of death are likely to be cancer and heart disease, the causes of significant lost years of life may extend to include suicide, accidents, violence and avoidable childhood diseases.
Morbidity data will show how such conditions as depression, diabetes, substance misuse, chest disease, and physical disabilities impact upon different social groups in different localities.
Equity and access
Linked to such data is the notion of equity and access – equity of outcomes and health indicators and access to health (and other) services. For example immunisation rates and attendance at screening services vary. Average life expectancy in many local authority areas will vary by 5 or more years between the healthiest and least healthy wards.
The council as a public health body
Despite the changes in 1974 when local government lost key health functions such as health visitors and medical officers of health, Local authorities have always had a key public health role beyond the narrow confines of Environmental Health. It is a key partner. Councillors should ensure they have machinery for assessing the nature and quality of their partnership arrangements.