Don’t play the hokey-cokey with health

By Nathan Elvery | 16 April 2019

In January, the Government announced to much fanfare the arrival of the NHS Long Term Plan, setting out how the £20.5bn budget settlement would be spent over the next five years.

While this is welcome – particularly with its renewed focus on prevention – an NHS plan without investment at local council and community level for public health will render it unachievable.

For this to be an effective prevention plan, one that can achieve real outcomes, the Government needs to fund public health, like all local government services, fairly, equitably and sustainably.

Cutting a further £85m from the council-led public health budget in 2019/20 is clearly not going to help achieve this, nor will it be of any tangible benefit to our NHS partners – not when they need more than ever effective preventative services within all our communities.

Equally concerning is the proposed ‘Trojan horse’ review of public health commissioning within local government for sexual health services, health visitors and school nurses, especially in light of sustained and improved public health service outcomes, against a backdrop of national cuts.

Returning some of these services to the NHS can only be a backwards step for our nation’s health.

In West Sussex, we have taken our responsibility for the county’s health and wellbeing very seriously, and have worked tirelessly over the last four years to integrate it into everything we do as an organisation and within our partnerships, including the NHS.

Our political leaders are incredibly powerful advocates for public health, and they are at the very heart of the communities who voted for them in the first place.

This is a factor that should not be underestimated as the NHS continues to look perplexed when local democracy is mentioned.

Within a two-tiered system of local government, there are the key partnership relationships with our district and borough councils, which are equally as important for achieving our ambitions for healthy and happy communities.

Working in partnership with the seven local authorities within our county, I have a central role as the wellbeing lead for the Chief Executive Group.

This has facilitated the partnership approach to developing the West Sussex Wellbeing Programme. It is a genuine success story, which allows us to work alongside our district and borough colleagues to deliver our adult prevention agenda within local communities, focused on modifiable lifestyle factors such as stopping smoking, maintaining a healthy weight and reducing alcohol intake.

Our Healthy Child Programme is integrated within children’s services to ensure the greatest reach to our families. Our public health team have also worked very closely with the county council’s catering services and school meals provider to achieve a 73% reduction in sugar in primary school meals over the last four years at no extra cost to the county council. Thirty thousand pupils a day benefit from this.

Would this have been achieved as swiftly and easily if public health services were returned to the NHS? After all, wasn’t this why we made the decision to move public health back to local government in the first place?

While we continue to face significant financial constraints, we have taken major steps to try toredress this challenge. Considerable work has taken place across the council to review spend against public health outcomes, to ensure that the quality of services remain high and are effective and efficient for our residents.

We have achieved this by embedding our public health staff across our council directorates, truly embedding public health into our organisation’s thinking, planning and delivery. We have also been working hard to protect frontline services by building on existing partnerships across the wider health and social care system, finding innovative ways to support our communities.

This can be seen in the way our Health and Wellbeing Board works, bringing together members and officers of the county council with representatives from the clinical commisisoning groups, the NHS and HealthWatch to deliver the aims of the public health agenda to achieve the benefits for all of our communities.

Unravelling all of this would achieve nothing other than to set us back several years, with our residents’ health bearing the brunt of all this.

We cannot play the hokey-cokey with such important issues – although a little knees bent, arms stretch is always good for our health.

Nathan Elvery is chief executive of West Sussex CC

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