On Thursday, Health Secretary, Andrew Lansley, addressed members of the Society of Local Authority Chief Executives (SOLACE). Read on for full details of his comments on the future of NHS and social care
“I’d like to thank and pay tribute to the effort and the expertise that leaders in local government have put into the health and care reforms. You’ve all been truly outstanding.
”We’ve asked a huge amount of you – and I’d like to thank all of you for the time, energy and commitment you’ve put in helping get these reforms right.
The truly radical bit in the health and care reforms is not the responsibility we’re giving to GPs and clinicians. It’s not that we are expanding patient choice. It’s not even the focus on quality in the NHS. The radical bit is actually about local government
”If you were following our reforms in the media, you’d be forgiven for thinking it was all about the NHS and GPs. But I’m sure, you like me, would be happy to put the media right on a variety of subjects.
”But, in my view, the truly radical bit in the health and care reforms is not the responsibility we’re giving to GPs and clinicians, that builds on past experience. It’s not that we are expanding patient choice. It’s not even the focus on quality in the NHS, vitally important as those things are. The radical bit is actually about local government. It’s about allowing local councils to do what they are best placed to do – to shape and improve the well being of their community. And it’s about a new kind of collaborative leadership – across the NHS, local government and communities – through the new Health and Wellbeing Boards. Genuine local ability to improve the lives of local people. It’s a very simple idea and one that’s been too readily forgotten over the past few decades. Its what I care about. I believe local government can deliver the very best.
“Delve back into history and look at some of the greatest and most influential developments in public health. They’ve come from local leadership.
Some history
“If you were just a mile or two west of where we are tonight, you have Broadwick Street in Soho. This is where, in 1854, John Snow, in the face of derision from fellow doctors, ended the cholera epidemic with the simplest of interventions. He took the handle off the water pump. He took the view that cholera wasn’t spread through the air – the culprit was dirty water.
You can talk all you like about the need for a more profound connection between health and other local services, but if all the powers are against change, then not much will change
“He was a local. He lived round the corner on Frith street. He lived and breathed the problem in a way that no lofty, so-called expert, geographically isolated and emotionally detached from the problem ever could.
“Because he lived there, because he could see the cesspits leaking into the water supply, because he saw what was happening to people’s health, he was able to join the dots and take what was to be a great leap forward for public health.
“About a decade earlier and a mile or two to the east, Victoria Park became the first public park in the world. Why a royal park slap bang in the middle of the East End? Because people in power started to realise that where we live is important. At the time, the Registrar General said ‘a park in the East End of London would probably diminish the annual deaths by several thousands…and add several years to the lives of the entire population’.
Public health
“But those ideas would never have been anything more than tinkering around the edges had the idea not been embraced by local government.
“It was only when cities embarked on programmes to light and pave their streets; when they chose to supply all their homes with plentiful and pure running water, and to connect working-class homes to mains sewer systems, that Britain as a society began to really evolve and advance.
I hope this shared sense of purpose and understanding can, and must, lead to powerful Health and Wellbeing Boards that work with communities to drive better services and improve their health and wellbeing
“It was the improvements in our homes, our streets and our schools, led by local government, that really began to extend life, to cut disease, to beautify our towns and cities and to civilise our environment for all of us.
“The air we breathe, the water we drink, having somewhere safe for our children to play – these things are important. These things mattered then and they remain every bit as important today.
“Public health – it’s about how people live and breathe. And, if you want to improve people’s health and wellbeing, you have to live and breathe their problems. You can’t do that from Whitehall, you can only do that from on the ground.
“That’s why, in more recent times, it was councils like Liverpool and others who pushed smokefree workplaces on to the radar of national government. They could see the difference it would make to local people – they were the visionaries.
“You might have heard some of this before. I’m definitely not the first politician to stand before you and tell you that local government has a vital role in improving people’s health. There’s been a lot of talk about this over the last few years, but too little action.
“You can ask every area to do a Joint Strategic Needs Assessment, but if it just sits on someone’s shelf gathering dust, it’s not worth the paper it’s written on, however many optimistic meetings you might have had with the primary care trust.
“You can talk all you like about the need for a more profound connection between health and other local services, but if all the powers are against change, then not much will change. But, as Einstein said, a form of insanity is to keep doing the same thing and expecting a different result.
“So we are now doing change. You are doing change. Change to devolve power; change to foster new clinical and professional leadership; and change to empower local democratic accountability in a new partnership between local government and the NHS.
Health and Wellbeing Boards
“Health and Wellbeing Boards will be genuine leaders in the design of local services, in devising the strategy that will deliver the most for local people, and in carrying it out with local partners. The boards will be the ones with the complete picture – from seeing and preventing the causes of poor health, to seeing how we can best care for people who live with long-term illness or disability.
We’ll be finalising allocations between now and the end of the year, so we have time to get this right
“The boards will lead the drive to join up services, making integration the name of the game, and to tackle health inequalities. And their success will depend on how local leaders work together, on developing relationships, creating the right culture and changing behaviour.
“This wont be easy, but by bringing together councils and councillors, with clinicians and patient representatives, we can bring to bear the sort of insight and creativity that John Snow and the founders of Victoria Park showed so long ago.
“It will be tough. Physical environments are easy to change. Culture is the hardest thing to change. Community shapes; not places.
“Some of you have spoken of the new positive connection you’ve seen when GPs and councillors come together for the first time… Two sets of people who have roots in their local community with a shared passion for doing the very best for their local communities and for making sure that strategies, rather than gathering dust on a shelf, are translated into action on the ground.
“I hope this shared sense of purpose and understanding can, and must, lead to powerful Health and Wellbeing Boards that work with communities to drive better services and improve their health and wellbeing.
Healthwatch
“And, of course, they will be doing all of this hand in hand with the local Healthwatch. A powerful advocate for local people on the Health and Wellbeing Board, it will be critical in making sure the boards tackle the issues that matter most to patients and care users.
“Every Health and Wellbeing Board will rely on committed and knowledgeable local volunteers to play a full role in improving local services. And it is crucial that the Healthwatch representative on board is provided with good, strong, open-hearted support. This includes supporting them to challenge as well as to collaborate.
“Healthwatch is a champion for local people. If those services aren’t up to scratch, Healthwatch will be your critical friend – highlighting the problems and working with you to find the solutions.
“They’ll need sufficient resources to do this and arrangements will vary. What I am enabling local government to do is to ensure that Healthwatch has a solid platform on which to operate and to be the strong independent voice that patients and care users want.
Public Health Outcomes Framework
“Across public services, we are for getting results. That means focusing on outcomes, not just inequalities or process.
Like any major change, there will be bumps along the road, and adjustments we have to make as we go along, but it doesn’t mean it’s not the right thing to do, or that we should give up
“When it comes to the indicators on the public health outcomes framework we’ve focused on the things that you’ve known for many years will tackle the causes of poor health and health inequalities. Some are obvious, like levels of obesity in children and reducing the number of people who smoke. Others are more complex, such as school attendance, school readiness, homelessness and air pollution. We’ve chosen these indicators because they accurately reflect the outcomes which have the greatest impact on people’s health – in particular, the health of the poorest.
“But as we know with any major change, when it comes to implementation, the devil is often in the detail. Governments before have talked a good game on local freedom, but the result has always been the same – more bureaucracy and industrial-scale form filling, divorced from what you were actually trying to deliver. We won’t do that on public health. We’re not telling you how to reach these indicators, or your priorities – that’ll be up to you.
“But you will be publicly accountable for the money you spend and what you deliver. We won’t replicate the heavy-handed performance management culture of the past, but we will expect to see something back from you.
“This is an opportunity to think differently about how we ‘do’ public health, and that’s the culture that you as leaders need to generate in your teams, wherever they come from.
“I will also support you to shape public health in ways that add value and that engage with the voluntary sector and your local communities.
“Public health should not just be about analysing the problem, it is about delivering solutions. You will look for those who can lead in doing that; and I will back you.
Money
“And then there’s the money to support your public health change. I have published baseline estimates: £5.2billion for public health, and a £2.2billion baseline for local government responsibilities. It’s a first step, and I hope it will go some way to helping you with planning for the responsibilities you’ll take on formally in 15 months.
“Again, I share your frustration – it’s taken us a long time to get to this point because the system didn’t know how much was being spent on public health, and the figures might not be what you were all expecting. What I do want to emphasise is that these numbers are estimates, not predictions. While no one will get less than what we’ve estimated, there will be some details we need to iron out. So, if you think we’ve got it wrong, please keep working with your primary care trust, and with us, so we can get it right. If you think our methodology can be improved, we’re happy to hear from you.
“We’ll be finalising allocations between now and the end of the year, so we have time to get this right. At the very least, they should be a good basis for planning.
“Like any major change, there will be bumps along the road, and adjustments we have to make as we go along, but it doesn’t mean it’s not the right thing to do, or that we should give up.
“Take a look at the local authorities who’ve led the way on issues like integration; local authorities like Knowlsey where they don’t talk about money for the NHS and money for social care – they talk about the Knowlsey pound, because it’s the same people of Knowlsey that they all work for. Whether it’s the logo of the NHS or the local council on their office is neither here nor there.
“Or look to Torbay, where they focused their vision for integrated care on a fictional older lady called ‘Mrs Smith’, with multiple health and care needs. So health and social care staff asked at every stage ‘What would this mean for Mrs Smith?’
Social Care White Paper
“I know there are sceptics who think we’re not going to bite the bullet on reform. Although I’m surprised if any of you think that I won’t swallow every bullet fired at me. Who suspects we’re going to consign issues to the ‘too difficult’ box?
“I understand why people are sceptical. You’ve had government after government, report after report, consultations and debates; all promising the answer, but few coming up with the goods. It is difficult. It’s because it is difficult that people haven’t done it before. But all the more reason for us to make it happen.
“There is much we know will make a positive difference:
- More-preventative, more-personalised care
- Portability of assessments
- Better information, advice and support
- Integrated services
- Strong safeguarding
- Effective regulation
“But I am not going to pretend that funding’s not the also a key issue – how we support growing numbers of older and disabled people is the problem faced by almost every major nation. And, as Andrew Dilnot said, how to enable people to prepare and plan must be a partnership between families and the state.
“It’s not just about how much money. As you’ll know all too well, these days, spending more money in one place means spending less or moving money from somewhere else. In the financially-challenged world we are in we have to know where the money comes from and the value it delivers. So it’s about thinking in a different way about how we support older people, disabled people and carers.
“The Caring for the Future discussions we had at the end of last year gave us the time and the space to do some serious thinking on these kind of issues, and it’s been all the richer for your support.
“More than 300 engagement events took place with the care and support community. We’ve had 640 separate pieces of correspondence, in the form of letters, reports, feedback forms and website comments. And thousands of people visited the website.
In the financially-challenged world we are in we have to know where the money comes from and the value it delivers. So it’s about thinking in a different way about how we support older people, disabled people and carers
“When I publish the White Paper in the spring, I hope you will recognise much of its content, because much of it is what you and your communities told us was important.
In conclusion
“No one underestimates the size of the challenge you’re facing in continuing business as usual while building for the future, in planning for transition as future leaders in the health and care system, and in modernising, reforming and changing.
“This is not something we can’t do because of financial and demographic pressures. It is something we have to do to deliver improving quality of care in the face of those challenges. We are addressing some of the biggest challenges of our generation, and you are on the frontline.
“But I have confidence in the exceptional local leadership I know is here in this room today to drive and shape this agenda and improve the health and wellbeing of the people in your communities. "
