Councils and NHS trusts to be free to set local public health targets

The public health white paper published last month lists a raft
of initiatives to persuade the NHS, local government and voluntary
sector to forge common ground – where “health” meets
“well-being”.

Progress on public health is to be achieved through an explosion of
local partnerships, joining the NHS with local government, the
voluntary and community sector and business communities.

Local authorities and primary care trusts are to be given the
freedom to develop their own local targets to improve public health
and tackle health inequalities. Councils are promised extra
government funding for hitting the more ambitious targets, an
approach already familiar through local public service agreements
(LPSAs). Indeed, in the second round of LPSAs, 36 councils are
already negotiating targets to reduce health inequalities.

Healthy Communities is also one of the three strands of similar
partnership deals – local area agreements – which are due to be
signed in 21 pilot sites in February.

And next spring, 12 councils will pilot a new scheme, Communities
for Health, where a partnership chooses a local priority for action
and works towards it.

In 2006 there are to be more Healthy Communities Collaboratives set
up in deprived areas, which aim to use team-building exercises to
effect changes that health professionals are unlikely to
achieve.

Involving the voluntary sector and community groups is seen as a
key to success in these partnerships, as they are best able to
engage those marginalised groups that traditional healthy living
messages do not reach. Food co-operatives and social enterprises
are the type of initiatives ministers want to encourage.

The white paper states:”The skills, know-how, social networks,
motivation, resilience, tradition and culture that can exist within
communities can be a powerful force for promoting and protecting
health.”

Eighty-eight “spearhead” PCTs (covering 70 local authorities) have
been identified as the most health-deprived in England, and will
pilot white paper initiatives such as health trainers and enhanced
stop-smoking services.

Local authorities and PCTs will also have a new obligation to
respond to annual reports by NHS public health directors, detailing
what progress they have made against last year’s priorities and
their plans for future action.

The emphasis on local government’s role in public health has been
well received. “Local councils play a key role in many of the
factors that affect public health, including education, tackling
poverty, sustainable development, housing and transport,” says
David Rogers, chair of the Local Government Association’s community
well-being board.

“It is encouraging that this role has been recognised by
government, but ministers must now commit to giving councils more
control and adequate resources to drive health improvement in a way
which best fits their areas’ needs.”

The white paper states that local authorities are to be reimbursed
for any extra costs they incur in implementing its objectives.
However, a fair proportion of the £1bn set aside by health
secretary John Reid for the document’s implementation has already
been earmarked to fund the proposals for personal health trainers
and for a substantial increase in the number of school
nurses.

Local government leaders have long called for more decentralisation
and autonomy from Whitehall and have welcomed a beefed-up role for
regional government offices in negotiating agreements reached
through local partnerships. But they have also expressed concern
about the lack of a cabinet minister to ensure government action on
public health is sustained and co-ordinated.

Association of Directors of Social Services president Tony Hunter
says: “There might have been more attention paid to shoring up the
cross-agency nature of the tasks by developing new structures
within central government, placing public health in the engine room
of government.”

• Choosing Health: Making Healthy Choices Easier, Department of
  Health, 2004. To view proposals go to www.dh.gov.uk and search under
  Publications and Statistics.