Is prevention still better than cure? How important is prevention to tackle issues such as substance misuse, obesity, teenage pregnancy and sexually transmitted infections? What are the knock-on costs of getting it wrong?
We councils called for more services, such as public health, to come under our democratic roof, seeing it as an opportunity to combine efforts right across our services to make an important improvement to health and wellbeing in our communities.
Public health was handed over from the NHS to upper tier councils, with the matching funds and staff TUPE'd across, protected for two years.
Councils strongly supported the transfer of public health to local government in 2013 as a major opportunity to make a real impact on the health and wellbeing of their communities. Since then, the Government has cut the public health ring-fenced grant by £531 million between 2015/16 and 2019/20. After that, the ring fencing will be removed and it will be up to councils to decide.
An extra £2.8 billion was announced for the NHS in the Autumn Budget and a small amount of new money for adult social care squeezed out at the last minute this year. Cutting the public health budget undermines our work to improve health and adds pressure on the NHS and adult social care. With rising demands, we calculate that councils will be £5.8 billion short by 2020, leading to a loss of council services. Will it be roads, libraries, children's services or public health?
A consultation of which services to secure in a mandate is out now. This is an important question as after 2020 the grant for public health drops to nothing, encompassed in the retention of business rates. The average amount of money for public health is about £60 per head, ranging from £39 in Shropshire to £135 per head in Kensington and Chelsea.
I was impressed with two excellent presentations on public health at the District Councils Network last week. Striking was the reminder from Stephen Dorrell that an estimated 80 per cent of our health is in our hands. It is now very much about making all our services work towards helping people live healthy for longer. We need NHS services as local as possible, giving the right care at the right time, but there is a lot we can do.
Many councils are taking on health trainers who work successfully with quite large numbers of people on reducing obesity, helping to keep people healthy for longer. Many councils also have staff in hospitals, helping people get the care and home adaptations they need before they can go home. Many have set up public walking groups, support community art, seated dance and lunch clubs to help prevent loneliness, with a backbone of professional staff and volunteers for the long term.
Planning authorities are adding a condition to planning permissions that a number of the houses built have to be to a higher standard, suitable for people who are older or with disabilities. Can we influence housing to be more adaptable or for young singles? Unfortunately, this has to be part of the package taken into account in the viability assessments. Getting enough quality housing that is genuinely affordable up to high energy efficiency levels with renewable energy and on the right tariffs has also been very effective work of our councils tackling fuel poverty and reducing chest infections. The growing use of technology such as lifelines, tablet reminders or activity monitors may help but must not replace human contact.
Age UK points out that a third of people diagnosed with dementia does not even have a care plan, the gateway to services. Is this not also part of the health of our public? It seems that everything we do touches the health of our residents. In the midst of budget season, let's put health at the heart of what we do.