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Councillor Jonathan McShane

Jonathan McShane is Portfolio Holder for Health, Social Care and Culture, for the London Borough of Hackney and Lead for Sexual Heath for the Local Government Association. In this month’s eFeature he considers the importance of new partnerships as the local government sector takes on a critical leadership role in local health improvement at a time of growing demand and diminishing resources. He acknowledges that councillors will be key to driving improvements in sexual health, and despite old sensitivities and commissioning complexities, is confident most are more than up to it.

Education to promote healthy lifestyles, sport and leisure programmes to increase physical activity, planning and housing to tackle damp and pollution: there is scarcely an area of local government that doesn’t impact upon the public’s health.  In Victorian times, local government pioneered and introduced the provision of clean water, universal education, decent public housing, food inspection and the detection and treatment of infectious diseases.  In the twenty-first century, we are building new partnerships and taking on a critical leadership role in improving the public’s health, of which sexual health is a key part.

Recognizing the additional demands facing the NHS in the coming decades – an increasing and ageing population, costly advances in treatments and rising expectations – we all accept that something has to change, and that is why councils very much support the transfer of public health to local authorities.

Many people have talked about this as a return of public health to its natural home in local government but I think the agenda is far more radical.  It is about developing a new culture in which health is at the core of integrated services, in which all parts of the council understand how they can contribute to better public health outcomes. Local councils are to provide the democratic “adhesive” that binds together the local effort for health improvement. Previously, their aspirations were hindered by the organisational separation of health and local government.

The new Health and Wellbeing Boards will be the key drivers of health commissioning for the local area.  They will bring together system leaders – elected members, representatives of clinical commissioning groups, directors of public health – to reform the system for delivering better health and wellbeing outcomes through integrated and personalised services. 

They will do this in the context of diminishing resources and growing demand so the challenges are great.  However, so too are the opportunities.  We have real opportunities to move from a top-down approach focused on process targets to develop local strategies which address local health needs and for all of the key players to work to the same priorities.

It is vital that Health and Wellbeing Boards engage in an honest dialogue with their communities about their health needs and local priorities and commission services that are best able to improve health outcomes.  This will entail difficult decisions about prioritisation and commissioning. The world after transition will not be without its challenges of course. What all parties need to recognise and contribute to is the building of quite a complex environment in which local authorities, the Government and the professionals all have a legitimate stake.

You could say that a perfect storm is heading for local government: a combination of growing demand due to our ageing population and poor economic situation, coupled with a dramatic reduction in resources of 28% in the current Comprehensive Spending Review period. You could also say that this presents us with enough challenge without taking on major new public health responsibilities. But rather than this being a reason to oppose change, these challenges provide an added spur for wholesale system reform.

To be blunt, our current health and social care system is unsustainable and will buckle under the weight of demand unless we re-engineer our planning and service provision to promote healthy choices, protect health, prevent sickness and intervene early to minimise the need for costly hospital treatment.  We need to reform all of our systems, services and plans so that they actively promote health rather than simply treatinga rising tide of illness and long term conditions.

We know that addressing the upstream measures and preventative approaches not only saves money, it also delivers better outcomes for individuals.

Health and Wellbeing Boards will be the engine house driving system reform. They are a wholly new type of council committee, where elected members sit alongside council officers, GP commissioning representatives and Healthwatch to agree joint priorities to address local health challenges.  They will also have a major influence on the commissioning plans of GPs.  They will need to develop a strong evidence base to persuade GPs to invest in upstream measures and public health in order to make the best use of scarce NHS resources.

Commissioning open access, confidential sexual health services is a mandatory responsibility for local government from April.  Council members, like myself, have an important strategic and community leadership role for their council and can use this to support efforts to ensure services meet national standards and are effective in achieving improvements in preventing the spread of sexually transmitted infections (STIs) and reducing unplanned pregnancies. Sex is still often a taboo subject and this can lead to ill-informed opinions about how best to address sexual health. Local politicians however are much more comfortable about speaking out on sexual health since the beginning of the HIV epidemic in the 1980s and 1990s. I don't for a moment underestimate the pressures and the complexities involved, but if we know what works most effectively to reduce the rate of teenage pregnancies and prevent sexually transmitted infections  then that's a good thing, and we should have the courage to support the evidence and say that. What may have seemed difficult at one time – a councillor talking about condoms – really shouldn’t be seen as something special at all.


The content of all eFeatures represents the views and opinions of the authors.  MEDFASH does not necessarily share or endorse the views expressed within them.

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