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Former health authority chief executive, David White, who now heads up a county, believes the NHS [Equity and excellence] White Paper is an exciting opportunity for local government. Now the dust is settling around Andrew Lansley's White Paper on the NHS, there seem to be three schools of thought. The Government would have us believe it is the most radical change since the creation of the NHS that will, through a process of creative disruption, bring about a revolution for patients. At the other end of the spectrum are onlookers, who predict only financial meltdown, as the major acute trusts have the upper hand at the commissioning table and GPs struggle to change entrenched behaviours and patterns of delivery. Caught in the middle is a cadre of world-weary managers feeling a profound sense deja-vu. I worked for eight years in the NHS as a chief executive of a health authority in the 1990s. I saw through GP fund holding, total purchasing pilots, locality commissioning, primary care groups and primary care trusts (PCTs), so I might be forgiven for sharing that sense of deja-vu. But, in fact, nothing could be further from the truth as I find myself excited by the White Paper and the opportunities it offers local government. As a citizen, I'm reassured, because when one strips away some of the managerial changes, one still finds a universal NHS, free at the point of delivery, with the doctor-patient relationship beating at its heart. Not only is this relationship to be preserved, it is to be enhanced as one increasingly between equals, given the choice agenda. As a chief executive of a county council, I'm excited because public health is coming home. In Norfolk, we have had some excellent joint working with our public health colleagues – including a joint intelligence team – but I know there is more we could do. Two of the biggest determinants of health, after all, sit within the gift of local authorities – housing and education. Within our sphere of influence, through our community leadership role, lies the economy and job creation, family and parenting support. All crucial, in terms of general health wellbeing and lifestyle choices. As the chief executive of a county where meeting the needs of our ageing population is the most critical challenge facing us going forward, I'm upbeat because of the potential the NHS White Paper gives. We can accelerate our agenda to integrate frontline health and social workers around GP clusters. We really do now have the full-blown opportunity to get close to GPs as commissioners, and influence their spend around early prevention and intervention to stop costly acute admissions and residential care. Previous reorganisations have been NHS affairs, with local government as concerned on-lookers. This time, we are well and truly at the table, which is a terrific vote of confidence in the sector. We must, however, use this opportunity wisely and sensitively. Yes, there is the chance to offer commissioning support to GP consortia. In Norfolk, we already have shared commissioning directors with the PCT, so would be well placed to do this. But, if we approach this as purely a business opportunity, or think the changes are just another set of managerial changes, we will neglect our wider community leadership role. The NHS moves at pace – often much quicker than local government. It might be tempting and expedient to dust off old copies of health improvement plans of the late 1990s to tackle the inequalities agenda, and rebrand joint investment plans as integrated commissioning. I think this would be an error. Local government needs to craft a new working relationship with the NHS – one which works with the grain of the very different culture of the NHS. We must get alongside GPs, to understand the levers and incentives which drive the NHS, and shift our current overview and scrutiny role to one of leadership, influence, and advocacy for patients through health and wellbeing boards. For me, a pre-requisite is the ring-fencing of any public health budget in the short term, although I know others are challenging this. This will allow a transparency about targeting these funds, and build confidence and assurance which scarce funds – that have, after all, been ‘raided' to plug other shortfalls in the past – will not suffer the same fate under a local government banner. These changes come at a time when local government is looking to re-trench, and redefine its role. There may be a challenge that says, can we afford to do this? Is this our core business? My response is that the health of our communities is fundamentally part of our core business. We can't afford not to, and as a consequence, I very much welcome this new agenda with open arms. David White is chief executive of Norfolk CC. He was formerly chief executive of Suffolk Health Authority as well as previously a director of social services at Nottinghamshire CC.

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WHITEHALL

Public health is coming home

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