It’s hard to find a part of local government that doesn’t affect our health in some way. From support for children and parents, to the maintenance of local parks and leisure centres, and the development of new housing – all of these have considerable influence over people’s physical or mental health. In recognition of this, in 2013 public health officially moved over from the NHS to local authorities. Many thought this would be an opportunity to build relationships with the huge range of local services which influence people’s health.
But public health teams had previously worked in a very different NHS environment and there were concerns that the transition over to local government would be difficult. Could public health teams develop effective relationships within local government? What financial, political and cultural challenges would they encounter? How would they overcome them?
NLGN’s recent report answers these questions. We found that public health teams had made very good progress integrating with certain parts of local government. Over 85 per cent of directors of public health felt that adult social care and children’s services departments were ‘very engaged’ or ‘engaged’ with the public health remit. There were also strong links with culture and leisure; and housing was generally well engaged, although moreso in unitaries than two-tier areas.
But there were some significant gaps that we found in our research. One area which was not as engaged with public health was economic development. Yet this is a key lever to shape health outcomes.
It’s well established that our work status affects our health. Long term unemployment is bad for physical and mental health, but it’s not just a question of ‘any job is better than no job’. Insecure and stressful work environments can be as detrimental to people’s health as unemployment. That’s why in the report we recommend that public health teams develop much stronger relationships with local economic development. Currently, only 12.8 per cent of directors of public health felt that economic development teams were very engaged with the public health remit. To improve people’s health and boost workforce productivity, public health teams should be involved in local growth strategies to ensure they are inclusive and generate decent quality jobs. Equally, economic development teams should proactively seek out the intelligence and input of public health officers.
Health and Wellbeing Boards could be a way for public health teams to develop new relationships and extend their reach. But our research showed there is a need to make them much more powerful. Established as part of the transfer of public health to local government, they should be a tool to improve local population health outcomes. Yet only 39 per cent of directors of public health thought that they were effective in addressing the wider determinants of health.
Making Health and Wellbeing Boards effective is about making sure they are right in both theory and in practice. To put this another way: are they looking at the right goals, and have they got the resources to achieve those goals? On the first question, some politicians and officers who we spoke to said Health and Wellbeing Boards had become dominated by discussion of Better Care Fund targets, and specifically, reducing delayed transfers of care from hospital. This limits focus on preventative work that would stop people going into hospital in the first place. And on the second, people also felt that Health and Wellbeing Boards didn’t have the practical resources to get things done, and had become a bit of a ‘talking shop’, just there to ‘rubberstamp’ documents and strategies.
Given these findings, we recommend that Health and Wellbeing Boards are given stronger powers in legislation and investment through a new £65million programme to address the wider determinants. Extending the reach of public health is dependent on a lot of factors, including teams having the capacity to drive forward change. Yet disappointingly, the recent Budget didn’t mention public health at all. In recent years, the public health grant has been cut, along with other local government funding. Central government must ensure public health teams have the funding and resources to address all of the wider determinants of health, and reflect the role of work in shaping our health.
Lucy Terry is Senior Researcher at the New Local Government Network. The report, Reaching Out: Influencing the Wider Determinants of Health, is available to download HERE.