The report, from Shared Intelligence, comes in the wake of suggestions from NHS England, in its Long-Term Plan, that some elements of public health commissioning should be returned to the health service.
Councillors from England’s largest councils said the report demonstrates these plans would be a ‘deeply retrograde step’, leading to spiralling additional costs and less investment in preventative services.
The County Councils Network (CCN), which commissioned the report, called on the government to enhance – rather than downgrade county authorities’ role in public health by deliver sustainable and ‘fairer funding’ for rural public health and bigger role for councils in commissioning wider services.
Public health services were transferred to local government in 2013 as part of a then controversial shake up the NHS services under the Health & Social Care Act. At the same time, government-imposed reductions to the ring-fenced grants councils received, whilst county authorities were allocated the lowest funding per-person.
Since 2015, county authorities have seen year-on-year reductions in public health grant funding totalling £113.6m, whilst they are the lowest-funded type of council for public health. This coming year, county councils will receive just £41 per head for public health services, 58% lower than councils in inner London who receive £100 per person, and 41% lower than metropolitan boroughs who receive £71.
Today’s report was based on in-depth interviews with local government and health officials in 14 county areas, concluding that councils’ commissioning and procurement practices have helped deliver better value for money and cope with the financial pressures placed on budgets. Download an infographic outlining the benefits here.
Senior local government officials interviewed as part of the research argued that prior to the transfer to local government, investment in public health services from the NHS was not necessarily prioritised, poorly targeted and inefficient. However, those from the health sector interviewed criticised the transfer, citing reductions to spending to traditional public health services.
Figures in the report show that while from 2014, spending fell in county areas on smoking and tobacco by £22.3m and by £20.7m on sexual health services, the outcomes for these services improved, with the percentage of smokers falling 4.1% and the rate of diagnoses for Sexually Transmitted Diseases (STIs) falling from 620 per 100,000 people to 560 per 100,000. Overall, healthy life expectancy for males also rose during the period.
The report concludes that public health services benefitted from being able to be integrated across other council functions – such as children’s services, transport, housing, and air quality – helping to tackle the ‘wider determinants’ of poor health.
However, it also found that in some areas, joint-working with district councils, Clinical Commissioning Groups (CCGs), and officials in Acute Trust boundaries were not as strong as other areas. This could be down to county-district relations, and the complexity of local health economies – with some county areas home to overlapping CCGs and hospitals.
In response councils say this is clear evidence that the transfer of public health services had been ‘undoubted success’, demonstrating that rather than services returning to the NHS, councils should have a much more wide-ranging role in health commissioning.
They also said that while councils’ ‘prudent’ financial management and better commissioning and procurement practices had helped councils implement government-imposed funding reductions, they are reaching the limit of the efficiencies that can be made, and rural areas do not receive their fair share of government resources.
Cllr David Williams, County Councils Network health and social care spokesman, said:
“The transfer of public health has been one of the good news stories for local government in the past six years. This research shows that the government was right to be ambitious about the potential of local government to take the lead in improving health locally and delivering better value for money.
“Councils’ financial track record and commissioning expertise has meant we have been able to make the best of a difficult situation that has seen grant funding cut year-on-year and counties receiving the lowest public health funding per year.
“Therefore, there is little logic in taking some elements of public health back from local government. In fact, it would be deeply retrograde step in improving health and care services. If the NHS Long-Term Plan is to be a success, government must enhance rather than downgrade local government’s preventative role.”
Shared Intelligence recommends that while the NHS and councils need to work more closely together, if government is to achieve its objectives for health and care integration and prevention, it is essential it builds on the wider place-based role of councils and the services is not shifted back to the NHS.
Phil Swann, executive chairman of Shared Intelligence, said:
“The transfer of public health to counties is having the impact the architects of the change envisaged it would. That is the core conclusion of this research based on interviews with directors of public health, senior councillors, council chief executive and other stakeholders in county areas.
“Action by public health teams is beginning to influence the wider determinants of health through joint working on planning, transport, housing and economic development. Council commissioning and procurement processes are enabling a move away from traditional services and going some way to mitigating the consequences of reduced budgets. Councillors have become powerful advocates for public health within councils and local communities.
“The research has identified several drivers of an effective public health function. These include the strength of the public health team’s relationship with the corporate core of the council and the effort devoted to relations with district council and health partners.
“This research underpins the importance of the recognition in the NHS Long Term Plan that action by health providers on prevention is a “complement to, but cannot be a substitute for, the important role of local government.” There is a need for a review of the relationship between the NHS and local government on public health, not to dilute the local government role, but in order to consolidate the position of public health in councils and build on what has been achieved since 2013.”
Notes to editor