Tuesday, 30 November 2010

Local leadership on public health

I have long been concerned about the state of public health in Reading. However, the more interested I was the more frustrated I became about the lack of influence local people, and local councillors have over local health matters.
I first got interested in the issue several years ago when I started reading public health profiles, published annually and distributed to all councillors. I was shocked by what I read about the extent of local health inequalities. I have blogged plenty of times about this over the last couple of years so I won't rehearse all the points here but the simple fact is life expectancy in our Borough varies widely between neighbourhoods and on many health indicators population health in Reading is a concern For example, not long ago tooth decay in Reading amongst the under 5s was amongstt the highest in the South East with too many young children having to have multiple extractions. It is well known that this is one of the key indicators of poverty. This was known about for years and yet nothing seemed to be said about it by politicians in charge.It's worth remembering that under Labour the number of children living in poverty in Reading went up not down. Good quality housing has a key part to play in improving the health of children and families hence I am committed to improving social housing and housing in the private rented sector.
Just over a year ago an independent assessment of Reading by the Audit Commission confirmed these depressing findings and indicated that health inequality in Reading was the worst in Berkshire . Reading this report and many others like was one of the reasons why I was motivated to lead a joint scrutiny review of children's health which revealed Labour's shocking failure to reduce poverty in Reading and the detrimental impact this was having on the health of local children.
At no point during my time as an opposition councillor or Chair of Scrutiny can I remember a Labour councillor in a position of influence showing anything resembling leadership on this issue. Who was challenging the PCT, GPs and the Department of Health - to find out what was being done to improve public health in Reading - particularly the health of the young children and famiilies? The silence from Labour seemed like complacency  at the time, or perhaps they had just run out of steam.
It was left to me as Chair of Health Scrutiny (2008-10) to get the issue on the political agenda and lead public calls for action. However, even as Chair of Scrutiny, HHCC Scrutiny Panel members and I struggled to land any meaningful blows - we found it near impossible to track all public spending by public agencies and to find out what was effective and why. Good quality, up to date data was thin on the ground and expert advice limited. Public involvement by health bodies on public health matters felt like an afterthought, an add-on, and council meetings just another bureaucratic hoop for health staff to jump through - rather than a joint-effort.
And it's not just just me saying it. Reading national reports produced by the Audit Commission and National Audit Office in recent years (for example on childhood obesity) make it clear that national targets and unprecedented levels of public spending on health have not delivered a reduction in health inequality - however well-intentioned. So we need to look at other models of improving public health - this must include looking at all the activities and policies led by councils including transport, housing and education to ensure they are leading to better health outcomes.
Today the Coaltiion Government made an important announcement which I hope will help us do more locally to improve public health: the responsibilty for improving public health is to be transferred from unccountable health bodies and civil servants to local elected councillors, as outlined in a white paper on public health, Healthy Lives, Health People. This is clear evidence of Liberal Democrat thinking on national government policy as Lib Dem MPs and councillors have spent years highlighting the lack of democracy in local health decisions.As Paul Burstow, Minister for Care Services outlines over on Lib Dem Voice, this will mean:

'An end to central control and a new opportunity for local government to lead with the freedom, responsibility and ring-fenced funding to innovate and develop local solutions to the local public health challenges they face. For the first time in a generation, central Government will not be pulling the strings.'
I've highlighted below some other key aspects of the proposals, care of the Department of Health website:
  • Directors of Public Health will be employed by the Local Authority and be the ambassadors of health issues for the local population.
  • Local authorities  will lead discussion about how the ring-fenced money is spent to improve health. This will include influencing investment decisions right across the Local Authority, with the goal of enhancing health and well-being.
  • Local authorities they will be able to make sure that public health is always considered when local authorities, GP consortia and the NHS make decisions.
  • To make sure that progress is made on issues like obesity and smoking, Public Health England will set a series of outcomes to measure whether people’s health actually improves.
  • Historically, money for public health has disappeared into other services. Under new arrangements, the flow of money will change so that: money will be allocated from the NHS budget and ring-fenced for public health; part of this will be used by Public Health England for population-wide issues; another part will provide a ring-fenced budget to Local Authorities.
  • A new health premium will take into account health inequalities and reward progress on specific public health outcomes, and we will consult on how we do this to get the detail right. The premium will be simple and driven by a formula developed with key partners. Disadvantaged areas will see a greater premium if they make progress, recognising that they face the greatest challenges.
Obviously only time will tell if these measures make a positive impact on public health in Reading. However, I believe they represent a step in the right direction towards improving accountability and transparency in relation to public health and I will be using all powers open to me to improve health outcomes for everyone in Reading, wherever they live and whatever their background.

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