Making the most of local area agreements

Using LAAs to combat health inequalities is all well and good in theory, but how do you use them to your best advantage and measure their success in the real world? Saba Salman finds out

In theory, local area agreements (LAAs) are contracts between central and local government to deliver the priorities of local people. In practice, they can be vital weapons in the fight against health inequality.

Local authorities have always had a role in quality of life issues, but in recent years, encouraged by central government, they have been increasingly shifted their focus onto health promotion. The current health agenda has seen an emphasis on prevention of ill-health and the integration of health and social care, with more innovative ways of joining up local services. The public health white paper Choosing health: making healthy choices easierin November 2004 and Our health, our care, our sayin January 2006 highlighted the enhanced council role in health promotion.

The aim of an LAA is to bring together organisations to run pooled budgets and strategies, co-ordinate local service delivery and joined-up working. Their nature means they are perfect tools to help tackle health inequalities. But how do you draw up a good agreement, what are some of the challenges involved, and how do you measure its success?

LAAs were launched by the government in 2004 and evolved from the earlier rounds of Local Public Service Agreements (LPSAs) which saw authorities negotiate a range of targets against which a reward grant was set. The idea is for shared goals to be delivered through strong local leadership with support from Whitehall. Councils, in partnership with health and local statutory and voluntary agencies, should meet the health challenges in their neighbourhoods including crime and anti-social behaviour, ill-health trends, and the long-term economic and social well-being.

LAAs, says the Improvement & Development Agency, are vital to the future health of the population. Ash Vithaldas, a principal consultant with IDeA's Healthy Communities Programme, says: &Quot;Major achievements around public health can take decades - local authorities via their elected members have that opportunity [with LAAs] to assume a leadership role in creating healthier communities and to focus on not just next year or the year after, but the longer-term future. There is a huge opportunity to create a legacy in terms of healthy communities.&Quot;

So how do you go about creating a successful LAA? According to IDeA, the primary care trust should be the first point of contact - in particular, the chief executive and director of public health. Other key contacts will be the leadership of the NHS organisations. It is also wise to ask for named staff in local health services who have been allowed time to work on the agreement.

One tip, according to IDeA, is to take into account that health staff will not be familiar with local government jargon. In meetings, council officers should illustrate to their healthcare peers how partnership working can boost resources for health and help them achieve their national or local performance targets.

Drawing up a detailed picture of neighbourhood health is a vital step in deciding targets. Local authorities, for example, can ask the PCT to map the types of health data that they have. Other sources include public health teams, the Regional Health Observatory and performance teams in PCTs or strategic health authorities.

Mr Vithaldas adds: &Quot;The data available on public health is not always to the standard that you would want it to be. For example, some PCTs do not have high-quality local information on obesity or under-age smoking. That is a key challenge. Within the first year an LAA can put into place systems that start collecting this data, and so in 12 months they have better data.&Quot;

Then you must set clear and measurable targets. There are four LAA priority areas - children and young people, safer and stronger communities, healthier communities and older people and economic development and enterprise. For example, a typical goal within the healthy communities and older people section of the LAA might include a percentage reduction in smoking within three years, or an aim to make all NHS premises and schools smoke-free within a year.

Setting priorities also means liaising with delivery partners such as those involved in the Local Strategic Partnership (LSP). Agreements should also reflect the local community strategy, the neighbourhood renewal strategy and the regional economic strategy. The agreement should explain who is involved in the partnership and how that partnership will deliver.

Successful LAAs also outline how voluntary and community organisations as well as local people will be involved in delivery. The agreement might explain how residents and the voluntary sector have been consulted and given the chance to engage. It will also explain what performance monitoring and management procedures will be used.

&Quot;An LAA is about how you can bring together under one umbrella a variety of different organisations, which focus on outcomes for communities, rather than outputs for their respective organisations,&Quot; adds Mr Vithaldas.

LAAs should also mention what funding will be used to hit targets. Mainstream sources include the revenue support grant, PCT and schools funding. Other sources include area-specific funding, like the Neighbourhood Renewal Fund, while bids could be made to regional development agencies, the Big Lottery fund or Sport England.

The relevant government office for the region will handle negotiation with the authority and partners, with final sign-off resting with the health secretary. Once an agreement is in place, a variety of local indicators are useful in measuring outcomes. The under-18 conception rate, obesity rates among children under 11 or access to child and adult mental health services, for example, are helpful in reflecting progress. There is a performance-reward grant element, whereby a number of the targets have stretch figures that, if achieved, will result in a grant.

But there are challenges to watch for in the process, say experts. For example, an area may lack detailed health data upon which to base targets and aligning NHS and local government targets can be tricky. Another issue is that because LAAs do not attract any additional money at the outset, some partners may not fully appreciate the agreement's potential as a source of new partnership funds. The Local Government Association is currently pushing for a 'duty to co-operate' to be placed on all partners of LAA.

So why do LAAs make sense? Work on an LAA now is in effect a huge investment in the social and economic future of an area - successful agreements can make a difference to life expectancy, for example. In addition, there is the advantage of taking advantage of central government's commitment to local priority setting and delivery.

The government has indicated that, in the longer term, it wants to continue to develop the policy.

&Quot;The rewards are the opportunity to know what is best for [the] community, to deliver for it and to do that without huge central control,&Quot; says Mr Vithaldas.