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Paper 3 - 27 March 1998 Meeting


27 March 1998

DEVELOPING PARTNERSHIPS BETWEEN HEALTH AND LOCAL GOVERNMENT - The Government White Paper 'The New NHS - Modern, Dependable' and Green Paper 'Our Healthier Nation'

Joint Report by the Health Policy Coordinator, Eastleigh Borough Council and the Association's Policy Officer


1. This Paper outlines the key policy and partnership issues arising from the White Paper and the recently published Green Paper taking into account the interim report of the Chief Medical Officer on strengthening the public health function in England.

Improving the Public's Health

2. The Government will introduce legislation to place a new statutory duty on Health Authorities to improve the health of their population. Health authorities will be charged with working in partnership with local authorities and others to identify how local action on social, environmental and economic issues will make most impact on the health of local people. Reference in the White Paper to the interface between health authorities and local authorities on public health concentrates largely on health surveillance, communicable disease control, assessing health needs, monitoring health outcomes and evaluating the health impact of local plans and developments (page 25, paragraph 4.5). However, the recently published interim report of the Chief Medical Officer on strengthening the public health function in England has effective joint working between health and local authorities as a key theme. It recognises that opportunities will be lost if practitioners from different backgrounds do not work together. The Chief Executives of these authorities are seen as providing a "lead in achieving a recognition of the cultural and process differences existing between organisations as part of developing shared values and objectives" (page 4).

3. Local Authority Chief Executives will be empowered to take part in Health Authority meetings (page 30, paragraph 4.21).

4. The role of the Director of Public Health and the annual public health report will inform the decisions of the Health Authority and its partners and will be the starting point for local Health Improvements Programmes (page 26, paragraph 4.6).

5. The White Paper also states that:

" To give substance to the co-operation necessary to bring about improvements in health, there will be a new statutory duty of partnership placed on local NHS bodies to work together for the common good. This will extend to Local Authorities, strengthening the existing requirements under the 1977 NHS Act. The Government intends to place on Local Authorities a duty to promote the economic, social and environmental well being of their areas. This will ensure that they have clear powers to develop partnerships with a range of other organisations including NHS bodies, to address the needs of local communities" (page 26, paragraph 4.8 - this is also referred to in the report at item 6 on modernising local government).

Health Improvement Programmes

6. The White Paper states "The Health Improvement Programme (HIP) will be the local strategy for improving health and health care. It will be the means to deliver national targets in each Health Authority area. The Health Authority will have lead responsibility for drawing up the HIP in consultation with NHS Trusts, Primary Care Groups, other primary care professionals such as dentists, opticians and pharmacists, the public and other partner organisations" (page 26, paragraph 4.7).

7. The key components of HIPs as set out in the White Paper will be:

8. to assess the health needs of the local population and how these are to be met by the NHS and its partner organisations through broader action on public health.

9. to meet the healthcare requirements of local people, and how local services should be developed to meet them either directly by the NHS or where appropriate jointly by social services.

10. to manage the investment required in local health services to meet the needs of local people.

The Green Paper 'Our Healthier Nation' sets out four key national targets as part of the national contract (or third way) for improving health. These are:-

* to reduce deaths from heart disease and stroke amongst people under 65 years by a further third

* to reduce accidents by at least a fifth

* to reduce deaths from cancer amongst people under 65 years by at least a further fifth

* to reduce the deaths from suicide by at least a sixth.

There is reference here to whether the local authority contribution to Health Improvement Programmes can be brought within the best value regime being developed for local government. "It is vital that both health and local authorities take responsibility for their part in HIPs" (page 40, paragraph 3.42).

11. "Our Healthier Nation" states that "taken together, the Health Improvement Programmes across the country , combined with the Government's role in the national contracts, will form a concerted national programme to improve health and tackle health inequalities. They will be in place by April 1999. We envisage that they will:

1. give a clear description of how the national aims, priorities, targets and contracts will be tackled locally;

2. set out a range of locally-determined priorities and, targets to address issues and problems which are judged important, with particular emphasis on addressing areas of major health inequality in local communities;

3. specify agreed programmes of action to address these national and local health improvement priorities;

4. show that the action proposed is based on evidence of what is known to work (from research and best practice reports);

5. show what measures of local progress will be used (including those required for national monitoring purposes);

* indicate which local organisations have been involved in drawing up the plan, what their contributions will be and how they will be held to account for delivering it;

* ensure that the plan is easy to understand and accessible to the public;

* be a vehicle for setting strategies for the shaping of local health services." (Page 40, paragraph 3.43).

The initial programmes will cover a three year period with annual reviews and periodic updates.

12. The Green Paper also highlights the wider public health contribution of local authorities through Health For All, Local Agenda 21 and their responsibilities for education, transport, social services, housing and the environment (page 44).

Primary Care Groups (PCGs)

13. The White Paper on the NHS suggests that Local Authority social services will join with GPs, community nurses, and possibly NHS Trusts to form new Primary Care Groups. The PCGs will be accountable to Health Authorities "...but will have freedom to make decisions about how they deploy their resources within the framework of the Health Improvement Programme".

14. PCGs will replace existing commissioning and fundholding arrangements and some will in time develop into freestanding Primary Care Trusts. The main functions of PCGs will be:

* to contribute to the Health Authority's Health Improvement Programme on health and healthcare, helping to ensure that this reflects the perspective of the local community and the experience of patients

* to promote the health of the local population, working in partnership with other agencies

* to commission health services for their populations from the relevant NHS Trusts, within the framework of the Health Improvement Programme, ensuring quality and efficiency

* to monitor performance against the service agreements they (or initially the Health Authority) have with the NHS Trusts

* To develop primary care by joint working across practices with the support of Local Medical Committees

* better integrate primary and community health services and work more closely with social services on both planning and delivery.

Although PCGs (ultimately in some cases Primary Care Trusts) will be able to run local community services, including community hospitals, they will not be responsible for either mental health or learning disabilities services. It is fundamentally important that health and local authorities co-operate to explore how this is to work in the context of a national contract for health, and the integration into HIPs of local health strategies.

15. Another major consideration is the requirement for PCGs to "... have clear arrangements for public involvement". There is clearly scope for working with local authorities here.

Integration of Health and Social Care

16. Integration is a major theme throughout the White Paper which states:

"In the future, patients with continuing health and social care needs will get access to more integrated services through the joint investment plans for continuing and community care services which all Health Authorities are being asked to produce with partner agencies. The Government will also be exploring the scope for even closer working between health and social services through, for example, pooling of budgets. The benefits will be particularly felt by patients, such as those with disability or mental health problems, who need the support of both health and social care systems" (page 27, paragraph 4.14).

17. It is not clear as yet how the present locality joint commissioning groups will relate to the new primary care groups. The effectiveness of local commissioning groups has been questioned at both a local and national level. Whilst in an embryonic stage, it is important that there is a line of communication between these groups, the new Primary Care Groups and Health For All/Healthy Cities Groups. This clearly links into the role of the new joint consultative committees. The White Paper on social services may give us more clues when published in the near future.

Health Action Zones

18. Health Action Zones are a new initiative to bring together organisations within and beyond the NHS to develop and implement a locally agreed strategy for improving the health of local people. There will be 10 Health Action Zones, generally covering an area of at least Health Authority size, commencing in April 1998.

19. Southampton and Eastleigh were the subject of a preliminary bid for a Health Action Zone submitted by Southampton and South West Hampshire Health Authority. This was submitted as an expression of interest and will be worked up for the next round of applications.

20. The purpose of Health Action Zones is to bring together all those contributing to the health of the local population to develop and implement a locally agreed strategy for improving the health of local people. The key objectives are to reduce health inequalities, improve services and secure better value for the total resources available. Partnership will be a key means of achieving these objectives. These strategies will also form part of achieving the targets set in local Health Improvement Programmes.

Healthy Living Centres

21. Healthy Living Centres are another initiative arising out of the Government's new health policy, linked to the New Opportunities Fund set out in a recent White Paper on the Lottery.


22. There is much to digest in the White Paper and the Green Paper and their relationship to documents from across Government departments. This paper focuses on raising awareness of the main issues for local authorities arising from the Government proposals.

Health Policy Coordinator, Eastleigh Borough Council

Policy Officer for the Association

References: (1) White Paper: "The New NHS - Modern, Dependable" Cmnd. 3807 1998 HMSO

(2) Green Paper: "Our Healthier Nation - A Contract for Health" Cmnd. 3854 1998 HMSO

(3) Chief Medical Officer's Project to Strengthen the Public Health Function in England - a report of emerging fundings. Department of Health, 1998.

Last update: 06/09/2000
Author: Nick Goulder, Policy Manager

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