NHS justified in transferring responsibility to local governments

By Dr. Ananya Mandal, MDJul 13 2011

Public health issues will be dealt hereafter by the local government that has a duty to look after the health and wellbeing of its population and there is an obvious synergy between public health challenges such as obesity, smoking and sexually transmitted infections, and local authority services such as housing, environmental health and education.

This was one of the few health reforms proposed by the British government that has been widely welcomed.

Public Health England (PHE) will take over functions of ‘quangos’ including the Health Protection Agency (HPA) and the National Treatment Agency for Substance Misuse. Originally the plan was for PHE to be part of the Department of Health, but responding to fears that it would be subjected to ministerial interference, the government decided at the end of its NHS listening exercise to grant more independence. A survey of members of the Association of Directors of Public Health in May found 81% agreed in principle with the move to local authorities.

Kieran Walshe, professor of health policy and management at Manchester Business School, said, “That will introduce a degree of democratic legitimacy to clinical commissioning group decision-making and bring some public health expertise directly back into the clinical commissioning group.”

The NHS spend on public health, about £4bn, will be redistributed to local authorities through a national formula. David Rogers, chair of the Local Government Association's community wellbeing board, is concerned about how the balance will be struck between local allocations and PHE. “The maximum should be transferred locally.”

Local authorities that make progress on public health outcomes are set to qualify for extra funding in the form of health premiums. But because the outcomes that matter, such as a reduction in childhood obesity, take too long to measure, the outcomes will be based on short-term proxies such as the number of smoking quitters. As Harrison warns, “areas that have largely white middle-class residents are going to improve their outcomes much quicker than areas that are economically and socially challenged”.

But Professor John Appleby, of the King's Fund, said even a doubling of the budget over 20 years was possible. Writing for the British Medical Journal website, he said it was about whether the NHS was prioritized even more. Ministers have spent the past few months arguing that the ageing population, rising cost of drugs and factors like obesity mean spending demands would outstrip what was affordable in the coming years.

Health Secretary Andrew Lansley suggested on current trends £230bn would need to be spent on health by 2030 compared to the £103bn which is spent now. He said that figure was one that the country “simply could not afford”.

But a Department of Health spokeswoman insisted such spending would constitute a “financial crisis”. She added, “The right approach is to change the way that the NHS spends its budget so that it matches patients' needs better - rather than simply spending much larger sums on patterns of care and service which don't match the changing health needs of the population.”