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This is a guest blog.
Guest authors bring different perspectives and diverse voices to our blog. They do not always represent the views of The King’s Fund.


Combined authorities: part of the cure for the ailing NHS?


  • Mubasshir Ajaz Photo

    Mubasshir Ajaz

I’ve had the fortune (or, perhaps, misfortune) to experience health care in action around the globe. Being Canadian and Pakistani by origin, I’ve been to public health care facilities that are as comprehensive as the NHS or in dire straits in the case public facilities in Pakistan, where then you must be wealthy enough to afford private health care to get decent care. Private health care is also the means of access for many in the United States, where I spent my university years. It is no surprise then that almost half the people going through bankruptcy in the US are doing so in part because of medical bills. So, a universal health care system with world-leading treatment capabilities, like the NHS, is something to treasure.

However, it needs help, and this need not be in the form of more money for doing the same things that have led to this current crisis, where A&E waiting times are high, where the elective care backlog is ever expanding and where our health workforce is left reeling, physically, mentally and financially.

The help will come when we start to consider health as being about more than just health care. It is an often-cited figure that 80 per cent of the causes for which people seek out health care services are about things that happen outside the traditional health sphere, about the wider determinants of health. These are about where and how people live and work, how much support and connection they have to their friends, family and communities, how easily they can get around their area to access vital services like schooling, good jobs and, indeed, quality health care. There is a wide recognition of this fact, but how do you go about tackling the wider determinants of health and ultimately help the NHS? This is where the role of place-based assets, be that local authorities or voluntary sector organisations, or other bodies that have statutory function that links to the wider determinants should be highlighted.

'How do you go about tackling the wider determinants of health and ultimately help the NHS?'

Mayoral Combined Authorities, such as the West Midlands Combined Authority (WMCA), play a key role here. With responsibilities that include Transport for West Midlands, a £130 million adult education budget, housing and brownfield redevelopment responsibilities and a mission to grow the region’s £117 billion economy even further, there is much to be gained by including a conscious focus on health improvement within these missions. To date, WMCA has done its share of tackling the wider determinants. Its adult education budget is used to boost the local labour market with skills enhancement and sustainable jobs, often targeted for those most in need of support and are underrepresented in the labour market. These initiatives respond to local needs, such as the health and social care skills plan, which aims to reduce workforce shortages in the sector. WMCA has worked with the Department for Work and Pensions to develop and fund the Thrive into Work programme, which uses individual placement and support principles to embed employment support within primary and community health care, giving sustainable employment to people with long-term health conditions or those who are at risk of going off sick due to health concerns. This work has led to more than 1,000 positive job outcomes in the past five years.

Focusing on improved health and wellbeing offer for employees in the region, the WMCA also runs the Thrive at Work programme, which works with employers across the Midlands to ensure they maximise opportunities to improve employee health and wellbeing. Apart from its good work agenda, the Local Transport Plan for the region, promotes walking and cycling through active travel and assists those most in need through ensuring transport links in more neighbourhoods and subsidised rates. WMCA works closely with bodies such as Sport England to bring further investment into the region and increase the number of people who are physically active, especially within groups known to face additional barriers in staying active.

'Through addressing some key wider determinants, WMCA helps create healthier communities that are productive, thriving and have less need for health care services.'

Through addressing some key wider determinants, WMCA helps create healthier communities that are productive, thriving and have less need for health care services. There is much more to do and given the link between thriving communities and thriving economies, combined authorities across England will be key to creating prosperous regions. The recently launched Health Foundation work on Combined Authorities Inequalities Programme will see eight regional authorities including Greater London Authority and Greater Manchester CA, work with WMCA and some newer CAs to consider best approaches to creating those prosperous regions through taking action for health. Recent work with The King’s Fund showcased the potential for even wider work a CA could do to influence the health of a region, including new ways of working with health partners that are supportive and add value to their work. There is a unique opportunity for combined authorities, to devolve more of the responsibilities that impact on the wider determinants of health, away from Whitehall and into regions led by Mayors for more place-based decision-making.

Health inequalities and systemic issues within the NHS remain a large concern and more must be done. With the formation of integrated care systems within the NHS, there is a chance for greater working as a system, with NHS organisations working closely with local authorities and their health and wellbeing boards. We all recognise the importance of the wider determinants of health, now it is time to make them equally important within our planning and decision-making. CAs are willing partners to the NHS and integrated care systems, in this work; it is now time to formally recognise both the contributions CAs can make towards health outcomes and the relationship that must be forged with the NHS, perhaps through integrated care partnerships, to make system-wide changes.