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A local government public health?


I missed the  Public Health Joint Statement 14 October 2011 produced by the LGA, Assoc of Public Health, NHS Confed, Faculty of Public Health etc. This is very relevant to the subject below and gives a useful bit of context. If anything it reinforces the points below – it is also worth having a look at Trevor Hopkins response to the blog in the comments below.

Original Blog

I am involved advising a couple of local authorities who like all unitaries are considering what public health might look like in the new world. As I have said in an earlier post – if we are to make the most of this transition we need to recognise that there will have to be a substantial cultural change in the way in which public health currently works. One of the challenges though is how radical can local authorities afford to be at this moment. They need to set the tone for the future, but not  destroy what is good or frighten off an already jittery public health profession.

One of the difficulties is knowing where to turn to for advice – the Faculty of Public Heath is in effect a craft guild whose primary concern is to protect the profession it has created – and there is nothing wrong with that. The problem arises when Local Government and National Government need independent advice. Advocating for the public health profession is not necessarily the same as advocating for a effective public health in local government terms. Of course the Department of Health has the same problem – it remains very reliant for advice on an embedded faculty function. This means that local authorities need to quickly come to a view themselves about what Public Health should look like.

Here are some of things that local authorities are considering at the moment.

Questions 1 and 2

Two of the questions a local authority councillor  needs answering when they are required to take on responsibility for a new service are:

Once they are clear about this they can then work out whether they have any resource to deliver more than the statutory minimum and create a service that also reflects local priorities and need.

Of course these questions becomes much more pertinent when times are tough. For example – there is a statutory duty for local authorities to provide library services – which requires all local authorities to provide a comprehensive and effective library service, set in the context of local need.

However closure of a number of libraries to ensure better, more efficient services does not mean that local authorities are in breach of the Act – as the residents of Brent have recently found out. This subsidiarity of local government will be further strengthened by the Localism Bill which proposes a general power of competence – local authorities are free to do anything so long as they don’t break any laws. This is of course a double edged sword – they can respond to local needs and priorities – but it is all within the context of government policies – in particular funding regimes.

You can see where I am going with this. I have not been able to find anything that clearly states what local authority public health duties will be after public health departments have transferred over AND who MUST be employed to deliver on this duty and how MANY of such people there should be.

Frankly, in the world of publicly funded services there needs to be a clear argument why certain skill sets are required to deliver certain statutory functions and I have not seen those arguments presented – in public health. If there are no clear arguments to be presented then I think it is perfectly reasonable for a local authority cabinet lead to argue that they could purchase the same skill set for half or two thirds the price of a person with a Faculty of Public Health badge.

I would be really interested if someone can point me at the legislation and associated guidance that spells this out.

Question Three

“I thought you were a public health department – but you seem to be passporting a whole load of NHS treatment services over to us?”

I have been quite suprised to see that a large part existing public health budgets – in some cases 50% –  to be transferred over to local authorities is for NHS treatment services. Specifically drug treatment and STD services. I know that an element of these is for population level prevention measures but I think that the bulk of this is for treatment of individuals.

I think this is a mistake for two reasons.

First, expertise for the management of treatment services such as GUM  services rests inside the NHS and accountability for their performance should rest there too.

Second, the small public health function in local government needs the management headroom to bring added strategic impact to its work with local government. One obvious way to do this is to free up management time by getting rid of clinical responsibility for treatment services and refocussing this capacity to work more with local government.

If this does not happen there is a real danger that the new local government public health function while being based in the local authority will continue to be distracted/seduced by the pull towards NHS clinical responsibilities.

What do you think?

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