Helping people to stay well for longer and thereby reducing pressures on cash-strapped NHS and council services sits at the heart of the London model of health and care reform, says Teresa O’Neil
Last year, local government and NHS partners in London agreed joint ambitions to improve the health of Londoners, as part of a shared aspiration to make ours the healthiest global city. Reducing childhood obesity by 10 per cent, helping a fifth of Londoners to achieve recommended rates of physical activity and gaining one million working days lost to sickness absence are just some of the challenges we have set ourselves.
‘In London, the NHS will have a funding gap of £4.65bn by 2020’
These city-wide aspirations, together with tailored priorities set through the 33 Health and Wellbeing Boards, demonstrate the ambition and impetus London Councils has been bringing to public health since taking on these functions in April 2013. We have embraced opportunities to weave public health thinking throughout our integration and reform agendas across health and care, and we have found willing partners in Public Health England, NHS England and clinical commissioning groups in the capital.
Last week’s announcement that government is going ahead with a £200m in-year cut to local authorities’ public health budgets is therefore disappointing, to put it mildly. This translates into £40m that London boroughs will have to cut in the last five months of this year, which will inevitably force many into curtailing contracts and scaling back ambitions for supporting their communities.
What should we read into this about the gap between national rhetoric about prioritising prevention and the reality that faces us on the ground? What does this say about the comprehensive spending review, due to be announced in a few weeks’ time?
The scale of future funding challenges facing local authorities and the NHS is common knowledge. In London, the NHS will have a funding gap of £4.65bn by 2020. London Councils has calculated that in the same timeframe London boroughs will face £2.4bn pressures in adult social care alone.
‘Shifting NHS spending from treatment to prevention is incredibly hard work’
Everyone agrees that more focus and funding should go on prevention – helping people to stay well for longer and thereby reducing pressures on cash-strapped NHS and council services. This sits at the heart of the London model of health and care reform, which councils and NHS partners are developing to meet distinct and varied needs across the capital. We are engaged in positive conversations with government and NHS England about devolution to support these reforms.
We were not successful in convincing the government that the £200m public health in-year cuts were a false economy. So what are our chances of securing a CSR outcome for both public health and social care that will enable local authorities to work with partners to make prioritising prevention a reality?
The government’s £10bn commitment to the NHS is clearly to be welcomed, but we know from local experience that shifting NHS spending from treatment to prevention is incredibly hard work. Strengthening collaboration and integration between local government and the NHS is key to making real and swift progress on this, but if local government is underfunded, it is harder to achieve our ambitions.
More done for less
Signals from government that council budgets could be in line for further reductions because we have previously demonstrated that more can be done for less to provide the best value for the taxpayer are worrying. Is local government’s success in maintaining or even improving outcomes for communities in the face of 40 per cent cuts over the past five years to be held against us?
I do hope that is not the case. I urge the government to reflect on the positive role that councils can play in helping to drive efficiencies across health and care systems and ensure that we are properly funded for social care and public health. This would enable us to be the partners in transformation that we want to be.
London Councils has set out a range of asks for public health in the CSR:
- treat local authority public health budgets consistently with the wider NHS budget. Doing otherwise is both unfair and short-sighted. Public health funding should be increased in line with the rates of increase in the NHS;
- reinstate the £200m cut this year into the baseline for 2016-17;
- devolve national programmes relating to primary responsibilities that already sit in local government such as HIV prevention;
- abolish the Health Premium Incentive; and
- prioritise prevention in the future Better Care Fund.
In the weeks leading up to the CSR, I urge the chancellor and colleagues to recognise the case for investing in public health as a route to improving outcomes and efficiencies across health and care.
Teresa O’Neill is executive member for health, London Councils