Local government's role in healthcare

Author: Alex Thomson, Localis (in The Guardian, Healthcare Network) - Dec 20, 2011

A dominant force in the health service until the 1940s and in public health until the early 1970s, in recent years local government has taken a back seat in the management of the nation's healthcare needs.

Though much has been improved in recent decades, few would claim that the present system is without fault, with bureaucratic box-ticking still getting in the way of the optimal service for patients, and vested interests forming potential roadblocks to much needed reform.

The forthcoming reforms to health and social care have led to wide discussion, but one element that has prompted little conversation is the reconnection of local government to health, which will re-establish democratic accountability at the most immediate level. With the impending demographic time-bomb of a rapidly ageing population, there is a pressing need to rethink the way the nation's health care is managed, and how it can best respond to new challenges.

Through the new Kent Health Commission, launched in November, local authorities are being given a snapshot of what their future, more dynamic role within the health system may be.

The commission – which brings together representatives from Kent county council, Dover district council, local GPs and other healthcare professionals to produce a series of recommendations for future best practice – is attempting to illustrate how early intervention can produce a more responsive system better tailored to patient need which, in these tough economic times, also ensures best value for public money.

This new system will offer up options beyond those always adopted hitherto, and options which may well be better suited to the needs of the patient. Yet this is not a charter to slash services, far from it. The provision of non-acute options will, of course, be subject to their meeting existing standards of good practice.

At the same time, the element of competition within the spirit of both the reforms generally and the Kent Health Commission itself is intended to drive a more patient-focused approach, not generate excessive profit for the private sector. Here, as mentioned, local government can provide an anchor to link the healthcare system to the need, and democratic right, of the patient to expect a certain level of care when required.

Building upon the previous healthcare successes of some of its practitioner participants, the commission is modelling a minimum 5% shift in budgets from acute to community care, and thereby seeks to take a more holistic view of public health.

Joining up the various health-related functions of district and county councils offers a way around a cycle of dependency upon expensive acute care which is both costly to the taxpayer, and unhelpful to the individual concerned.

By making proactive use of the powers of both district (such as leisure functions) and county (including social services) councils, the new health reforms can help usher in a new era of joined up provision which begins before an ailment has even manifested. At the same time, by harnessing the expertise of those bodies outside the NHS, a more personalised, less monolithic healthcare landscape can emerge when people do require treatment.

Where modern technology (such as telecare) allows people to be treated in the comfort of their own homes, it should do so. Where the vulnerable both need and want human contact to help them manage their conditions, they should have access to it.

Crucially, the point of all this is not mere cost-cutting. Any savings accrued by shifting money from acute to community budgets will be reinvested back into the health system. The Kent Health Commission is offering an important lead on the road to reconceptualising health care, and I would encourage those who wish to contribute to its ongoing work to take a further look.

Click here to read the to read the original article