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Public health responsibilities returned to local government Matthew Warburton - 04/04/2013

health_housing_300Commencement of the bedroom tax and other imminent welfare reforms stole most of the headlines over the Easter weekend, but there was still room to report widespread concerns about the changes to the NHS that also came into effect on 1 April.

Worries about the transfer of responsibility for most commissioning from Primary Care Trusts to GPs have focused on the dubious wisdom of imposing such radical reform so rapidly on already-stretched services, coupled with suspicions that the government's underlying agenda is about privatisation by stealth.

Little attention, in contrast, has been given to another element of the reforms which is much less controversial and, unusually in current times, good news for local government. From 1 April, responsibilities for promoting public health were returned to local government.

As every student of housing and local government learns, the need for effective action to tackle overcrowding, insanitary conditions and deteriorating public health in Victorian Britain was one of the main reasons for the emergence of local government in its modern form, not to mention its involvement in housing.

Councils remained central to the improvement of local health until NHS reorganisation in the 1970s transferred their public health responsibilities to PCTs. Critics have always questioned the wisdom of putting public health in with the much larger local budget for clinical services under the direction of a board dominated by clinicians, arguing that this would risk public health becoming a Cinderella service.

Worse, separating public health from other local services, including housing, lends support to the mistaken idea that only medical professionals have a role to play in health promotion, protection and disease prevention.

The resumption of a local authority role in public health provides the opportunity for councils to demonstrate the benefits of a co-ordinated approach to health promotion that links together the work of all local services, from housing and social services through to education and transport.

It would be an easier opportunity to grasp if the detail of the reforms had been different. The CLG Select Committee, which has just published a report on the role of local authorities in health issues, concludes that councils "will need to use every power, department and service at their disposal... if they are fully to grasp this opportunity" criticises the government for late announcement of local public health budgets, and recommends a number of tweaks to make the new arrangements work better. If the government is keen to see at least one part of its NHS reforms judged a success, it will do well to take heed.

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