Roundtable disccussion: 'New directions, new cultures: working together to improve health'
On 10 November 2010, Local Government (LG) Improvement and Development's (formerly IDeA) Healthy Communities programme hosted a roundtable discussion. This explored how local authorities and clinicians can work together on an operational level to take on the new responsibilities signposted in the NHS White Paper. This is likely to be expanded upon in the forthcoming Public Health White Paper and Health Bill, as well as future white papers on adult social care and mental health and wellbeing.
Participants at the roundtable included senior representatives from local authorities, public health, primary care trusts (PCTs), GP consortia, professional bodies, the voluntary sector and from the academic world.
Throughout the discussions, all participants demonstrated a real commitment to working together to meet the needs of communities. It was felt that, collectively, we should be working to deliver transformational change, creating a fully integrated, place-based health and social care system, led by local councillors. Work is already well advanced to create such a system in some areas. Within Yorkshire and the Humber, for example, a change lab is taking place to design a new integrated approach to public health provision.
Elected member leadership
The roundtable was held before the publication of the Public Health White Paper. However, participants were clear that democratic leadership is vital to the delivery of an integrated health and social care system that leads to improved health for the public. Elected members must be encouraged to take on the challenges of improving health in their communities, particularly increasing disability-free life expectancy and tackling health inequalities.
Some local authorities are already providing effective leadership. They are exploring how to work with partners to implement new structures that deliver improved outcomes for their communities. East Riding of Yorkshire Council, for example, has groups looking at resource allocation and transition of services from the PCT to the council. East Riding is also considering how it can be more proactive in providing public health interventions in fields such as geriatrics and smoking cessation through council facilities including leisure centres.
Hertfordshire and other authorities are currently working with the Department of Health (DH) to pilot the development of a Health and Wellbeing Board.
It was acknowledged that not all local authorities have quite such advanced plans to take on their new and additional health responsibilities, and resource constraints are worrying all. It was suggested that further work needs to be undertaken to demonstrate the social, environmental and economic business case for health improvement. In particular, the long-term impact that local authority investment in health intervention programmes can have on areas like the demand for residential care needs to be emphasised.
The risk that health inequalities might increase following the transfer of health responsibilities to councils and their local partners, and the corresponding reduction in national targets, was acknowledged.
Local authorities and clinicians are increasingly recognising the need to work together on health improvement. Good examples already exist whereby authorities work closely with health professionals. In Staffordshire, for example, an adult health and social care foundation trust is being established that will deliver a public health service. Within Leeds, the Leonis Healthcare Consortium is working with the council on projects designed to better integrate data and join up commissioning processes.
As well as developing area-wide partnerships, there is a need to establish more local, possibly ward level links, between GPs and local councillors. Community representatives, schools, leisure centres and other professionals such as health visitors, may also be involved. This is to develop responses to local health challenges and inform commissioning processes.
A number of significant challenges in joint working were identified, the most significant of which relate to different focuses and organisational cultures.
Not all GPs are familiar with local government's methods of operation. Traditionally they had little involvement in the preparation of key documents such as joint strategic needs assessments (JSNAs). Ward councillors have not routinely worked with GPs. GPs have always only been responsible for the health of their list of patients and have not had responsibility for the health of an area. Consequently, some GPs will have less understanding of the health inequalities present within a local authority's area or of patterns of health in communities.
Co-terminosity is an issue too. Should GP Consortia be required to have some common boundaries with local authorities so as to simplify commissioning and partnership arrangements? Should GP consortia have a duty of partnership?
Whereas councils are more likely to focus on addressing the social, environmental and economic determinants of health, GPs are more likely to view public health as ‘health protection'. They may be more focused on keeping people out of hospital and on treating illnesses as they arise, rather than prescribing preventative programmes in areas such as smoking cessation.
Principal Consultant - Healthy Communities Team
7 December 2010