Public health and local democracy

16 Jul 2010 by Karl Hallam

Cadence recently did some work on making the business case for local government in relation to health. We used the example of health inequalities to tease out some of the issues, focusing on the environmental and social causes of them. It is therefore interesting to see the health white paper this week that suggests public health at least is going to become a local authority responsibility. In Public Finance this week there are some doubts being expressed about how good a thing this will prove to be, particularly in relation to another eye-catching part of the white paper, namely the new commissioning role for GPs.

The headline says 'Councils welcome public health role but fear GPs will ignore them'.

The article adds that 'Lansley's proposals, which only affect England, would give councils control of the £4bn public health budget, which is to be ring-fenced. Local government would also be given a role overseeing local NHS strategy and partnership working between the health agencies and other local bodies. But commentators are already worried that councils will be effectively powerless over commissioner-GPs'.

These seem reasonable concerns, as one possible benefit of council control of public health should be greater accountability, through the ballot box, for a very important issue. Could councils exert pressure, on the basis of a democratic mandate, on GPs to commission preventative public health measures? 

The work Cadence did posed the question whether PCTs and Strategic Health Authorities would support more council involvement in public health, that now seems a very dated question to ask. In other bits of work we have supporting 3rd sector organisation in moves to be commission-ready ... does this now mean getting out and meeting GPs? We look forward to seeing more detail soon. 




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