The impotent PHE is an opportunity for councils in the UK to take the lead
An enhanced sector-led improvement approach, where councils are responsible for their own performance and are held accountable locally, not nationally, would be a cost-effective way to boost public health
Public health has been at the heart of the local response to the pandemic, from the leadership provided by directors at a senior level based in councils, to the school nurses, midwives and health visitors doing all they can to support the most vulnerable in our communities.
Since 2013, local authorities have been responsible for public health services, ranging from drug, alcohol and substance misuse treatment, early years, and school aged support, to weight management, mental health, and sexual health services.
The coronavirus crisis has brought out the best in our dedicated council staff and their colleagues working in commissioned services, including stepping up to take on more responsibilities alongside the national level, such as contact tracing, mass testing and offering to help encourage take-up of the vaccine.
During this sudden and ever-changing landscape, we have also seen some more fundamental reforms. Over the summer it was announced by secretary of state Matt Hancock that Public Health England would be abolished and replaced with the National Institute for Health Protection, leaving the national prevention and health improvement functions up for discussion.
The establishment of the NIHP has provided the opportunity for councils to take the lead and build on the “local by default” approach to improving and protecting our communities’ health.
The Local Government Association, together with the Association of Directors of Public Health and the Society of Local Authority Chief Executives, have co-signed a letter to the secretary of state about the urgent need to ensure we do not lose focus on health and wellbeing improvement.
This includes tackling the wider determinants of health and the “levelling up” of health inequalities the pandemic has exposed and exacerbated.
Every pound invested by government in council-run services, including public health, helps to relieve pressure on other services like the NHS, social care and the criminal justice system
Our joint proposal is about an enhanced sector-led improvement approach, where councils are responsible for their ownperformance and are held accountable locally, not nationally, supported by the LGA and others. This provides a sense of collective responsibility for the sector as a whole and comes at a fraction of the cost of alternatives, such as government-mandated inspections, representing significant value for money.
Every pound invested by government in council-run services, including public health, helps to relieve pressure on other services like the NHS, social care and the criminal justice system. Public health investment has also proven to be three to four times more cost-effective in improving people’s health than money spent in the NHS, according to the Centre for Health Economics at York, thereby supporting the health service without it being delivered through the health service.
Combined savings from the cost of drug and alcohol treatment alone amount to £2.4bn every year according to Public Health England’s own research, while the National Institute for Clinical Excellence says that every £1 spent on smoking cessation saves £10 in future healthcare costs and health gains. International studies show that every £1 spent on public health returns an extra £14 on average on the original investment.
Meanwhile, 40 per cent of avoidable deaths are because of tobacco, obesity, inactivity and alcohol harm, showing there is still much more to be done. No new funding for public health in the recent Spending Review makes this incredibly challenging.
Coronavirus has also disproportionately impacted certain groups of people, such as those who are overweight or obese, diabetic or with other physical and mental health conditions. By intervening earlier and helping to prevent some of these conditions from developing in the first place, more lives could have been saved.
Our proposed SLI approach builds on the successes we have already made in improving children’s and adults’ social care and the work already happening in public health teams. This also draws in all of councils’ activities, such as housing and planning, to improve health outcomes.
This includes, for example, ensuring better quality housing and insulation so that people do not need to be treated for illnesses directly linked to living in cold, damp and dangerous accommodation.
The “enhanced” element of SLI is a recognition of the need to ensure there is robust challenge and accountability, both locally and nationally, to achieve the best outcomes for local people, supporting improvement and shared learning.
Greater local responsibility for public health means councils will have clear accountability to their residents and nationally to ministers, through their locally elected leaders, directors of public health and chief executives.
Our offer would provide support across the breadth of public health responsibilities around protection, healthcare, public health, health improvement and reducing inequalities. This covers services as diverse as alcohol, drugs and substance misuse, mental health including suicide prevention, child health covering those aged 0-19, obesity, smoking and sexual health.
Examples of how this could help councils support each other is in finding and sharing new and improved ways to reach out to residents, such as expanding home testing and web-based delivery in sexual health and contraception services.
Sector-led improvement is a cost effective, established and evidence-based method of monitoring and improving performance. The future of public health needs to be place-based and locally-led, building on, and strengthening connections with national and local levels, for the benefit of improving the health of everyone in our communities, no matter where they live.