House of Commons Communities and Local Government Committee The role of local authorities in health issues Eighth Report of Session 2012–13 Volume I: Report, together with formal minutes, oral and written evidence Additional written evidence is contained in Volume II, available on the Committee website at www.parliament.uk/clgcom Ordered by the House of Commons to be printed 20 March 2013 HC 694 Published on 27 March 2013 by authority of the House of Commons London: The Stationery Office Limited £24.50 The Communities and Local Government Committee The Communities and Local Government Committee is appointed by the House of Commons to examine the expenditure, administration, and policy of the Department for Communities and Local Government. Current membership Mr Clive Betts MP (Labour, Sheffield South-East) (Chair) Bob Blackman MP (Conservative, Harrow East) Simon Danczuk MP Rochdale (Labour, Rochdale) Mrs Mary Glindon MP (Labour, North Tyneside) David Heyes MP (Labour, Ashton-under- Lyne) James Morris MP (Conservative, Halesowen and Rowley Regis) Mark Pawsey MP (Conservative, Rugby) John Pugh MP (Liberal Democrat, Southport) Andy Sawford MP (Labour, Corby) John Stevenson MP (Conservative, Carlisle) Heather Wheeler MP (Conservative, South Derbyshire) Heidi Alexander MP (Labour, Lewisham East), Bill Esterson MP (Labour, Sefton Central), Stephen Gilbert MP, (Liberal Democrat, St Austell and Newquay) and George Hollingbery (Conservative, Meon Valley) were also members of the Committee during this inquiry. Powers The committee is one of the departmental select committees, the powers of which are set out in House of Commons Standing Orders, principally in SO No 152. These are available on the internet via www.parliament.uk. Publication The Reports and evidence of the Committee are published by The Stationery Office by Order of the House. All publications of the Committee (including press notices) are on the internet at www.parliament.uk/parliament.uk/clg. A list of Reports of the Committee in the present Parliament is at the back of this volume. The Reports of the Committee, the formal minutes relating to that report, oral evidence taken and some or all written evidence are available in a printed volume. Additional written evidence may be published on the internet only. Committee staff The current staff of the Committee are Glenn McKee (Clerk), Sarah Heath (Second Clerk), Stephen Habberley (Inquiry Manager), Kevin Maddison (Committee Specialist), Emily Gregory (Senior Committee Assistant), Mandy Sullivan (Committee Assistant), Nyree Barrett-Hendricks, (Committee Support Assistant) and David Foster (Assistant Media Officer). Contacts All correspondence should be addressed to the Clerk of the Communities and Local Government Committee, House of Commons, 7 Millbank, London SW1P 3JA. The telephone number for general enquiries is 020 7219 1234; the Committee’s email address is [email protected] The role of local authorities in health issues 1 Contents Report Page Summary 3 1 Introduction 5 Health and Wellbeing Boards 6 Public Health England 8 The NHS Commissioning Board 9 Local Healthwatch 9 Health Scrutiny 9 Reaction to the transfer of public health responsibilities back to local government 10 Our inquiry 11 Our report 11 2 Public health at the local level 12 The role of Health and Wellbeing Boards 12 The priorities of Health and Wellbeing Boards 15 Accountability 16 Healthwatch 18 The position of national organisations in guiding and advising Health and Wellbeing Boards 19 The NHS Commissioning Board 20 Structure 20 Relationship with Health and Wellbeing Boards 21 Local accountability 22 The NHSCB’s role in holding other bodies to account 23 3 The development of Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies 25 Introduction 25 Data sharing and information management 26 Building relationships with other sectors 28 Collecting and analysing information 29 Communicating information 30 The engagement of councils and councillors 32 Two-tier authorities 32 Unitary authorities 34 Housing 34 The role of Clinical Commissioning Groups 35 Councillors and Clinical Commissioning Group Boards 36 4 Public health in practice 38 Tackling the causes of the causes of poor health 38 Early years 42 Employment 43 2 The role of local authorities in health issues Local authorities working with the Government 44 Joined-up government 46 Measuring success 47 Assessment bodies 50 Self-assessment 50 5 The national perspective 52 Introduction 52 Front-line health protection 52 The role of Public Health England 52 The role of the NHS Commissioning Board 55 The role of Directors of Public Health 56 Screening, immunisation and the NHS Commissioning Board 57 Childhood services 60 6 Finance 62 Introduction 62 The draft interim allocation 63 The final allocation 64 The revised formula 65 The Health Premium 66 Demand-led services 67 Re-charging for non-residents’ use of services 69 Funding in the long term 69 Moving away from ring fencing 69 Community budgets 70 7 Conclusion 73 Conclusions and recommendations 75 Formal Minutes 88 Witnesses 89 List of printed written evidence 90 List of additional written evidence 90 List of Reports from the Committee during the current Parliament 92 The role of local authorities in health issues 3 Summary The return to local government on 1 April 2013 of a responsibility to improve the health and wellbeing of local people is welcome. Councils, through the services that they commission and deliver, already have an influence over the day-to-day conditions in which people live, so they are well placed to make the most of a move away from a medical model of health, based on clinical treatment, to a social model, based on health promotion, protection and disease prevention. They will need to use every power, department and service at their disposal, however, if they are fully to grasp this opportunity and tackle the causes of the causes of poor health: the social, economic and environmental reasons why people experience ill health or develop unhealthy behaviour. Central to the new system will be Health and Wellbeing Boards, whose members include councillors, GPs, directors of local services and community groups. They will need to focus on health promotion among all age groups, not become constrained by an undue focus on health and social care commissioning and integration. With few powers and no budget to commission services themselves, they will have to display leadership, build relationships and use their influence locally to turn their health and wellbeing strategies into reality. Individual authorities will have their own priorities, but we recommend that they bear in mind the importance of early years interventions. We also call on the Government to consider devolving more employment initiatives, including elements of the Work Programme, and conclude that Ministers must be prepared to use national levers to underpin public health initiatives at the local level. Health and Wellbeing Boards will be part of a complex new structure, including Clinical Commissioning Groups and two new national bodies, Public Health England, which exists only in shadow form until April 2013, and the NHS Commissioning Board. Many are still unclear who will be in charge locally in the event of a health emergency, and the Government needs to set out the lines of responsibility between these organisations and confirm that Public Health England will have sufficient staff in its local teams to deal with contingencies. We also recommend the Government reviews new regulations restricting the local Director of Public Health to acting as an adviser on emergency arrangements. The new arrangements for screening and immunisation services are the responsibility of the NHS Commissioning Board, but they lack a local dimension. We see a strong case for devolving these services, along with public health services for children up to five years old and childhood immunisation services, to public health staff within local government under Directors of Public Health. There are still concerns that not all Directors of Public Health will report directly to local authority chief executives. They appear to have conflicting responsibilities for accountability, both sitting on and policing Health and Wellbeing Boards. We welcome the increase in ring-fenced public health funding, but its delayed announcement left local authorities with a great deal of work to do to finalise their budgets in a short period and should not be repeated. The grant formula also contains a perverse incentive. Over time areas that perform well might have their funding reduced. This needs to be reviewed, especially given its conflict with the Health Premium, which rewards 4 The role of local authorities in health issues improvement in reducing health inequalities. The Premium seems unfit for purpose in itself and should at least be delayed until a better formula has been devised. In the medium term, if public health is to become an overarching priority for all local authority departments, it will require an overarching budget, and we call on the Government to provide local authorities with community budgets to direct resources at people and places, rather than organisations. The Government needs to address concerns about local authority and NHS access to each other’s data. Councils will need staff in place who can analyse that information and turn it into strategies that local councillors and communities understand. The Government also needs to establish a single point of ministerial contact to support local authorities in their new health role. Health and Wellbeing Boards will need guidance from NICE and Public Health England, but regulation and scrutiny should take place locally, through Healthwatch and local overview and scrutiny committees. It is unclear how local accountability in the new arrangements extends to Clinical Commissioning Groups, and we question why councillors should be barred from sitting on Groups’ Boards. The role of local authorities in health issues 5 1 Introduction 1. Local government is responsible for many services that affect the conditions in which people live—conditions that in turn affect the length and quality of people’s lives.