Local government and public health: a critical year ahead

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Today we publish our independent assessment (commissioned by the Local Government Association) of the local government public health reforms of 2013, which placed responsibility for many public health functions with local government. These reforms were overshadowed by the debate on the Coalition government’s NHS reforms but were every bit as significant. The rationale for them was clear: if we take the evidence seriously about what determines the public’s health, then it makes more sense for many key public health functions and services to be in local government than in the NHS, and it is more important still for public health expertise to influence local government’s wider decisions over economic development, housing, transport and environmental policies to name but a few.

The sting in the tail of course is that this transfer has been followed by real-terms cuts by central government to public health and wider local government budgets. Our overall view then, is that these were the right reforms but that the government did not support them with the right level of resources. Recent work by the Centre for Health Economics demonstrates what a huge mistake that has been, showing that funding these services through the local government grant is three to four times as cost effective in improving health than if the same money was spent in the NHS. Our spectacles are not, however, rose-tinted. Local government now has to focus more on demonstrating its impact on health outcomes; showing that it is efficient and is successful in reducing unjustifiable variation. Public Health England should also play a larger role than it currently does in helping ensure this happens.

But our report is not solely backward looking. While predicting the future is a fool’s game, the government has announced (before the election) that the budget for local government public health would at long last see some real increase in 2020/21 (though it has been conspicuously silent since). Given the evidence above, there is a stronger case than ever before for local government public health to be at the front of the queue for any resources flowing from the March Budget. Our joint position with the Health Foundation is that this requires at least a £1 billion increase in annual spending.

Further, three important pieces of work are coming over the next three to six months: the government’s next steps following the prevention Green Paper; the 2020 Marmot review of health inequalities; and the report from the All-Party Parliamentary Group on Longevity on how the government can meet its own Grand Challenge on Ageing of ensuring five years more healthy life expectancy for the population by 2035 while narrowing inequalities. Each of these pieces of work need to recognise and prioritise the contribution of the local government public health function and its expertise, and the government needs to build on its welcome decision to keep public health in local government by responding positively to their recommendations. Beyond this, local government will be a key player in meeting any broader vision for the population’s health. The King’s Fund will also be investing more in our own expertise and capacity to support this across our forthcoming new strategy.

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