Browse By

Review of (part of) The Year

This is a review since 7th August, to be precise. Why?  Because that’s when I had my health and wellbeing policy updates in a database format with a significance score attached to each news item.  Which means I can select the top 10 or 20 items and, with the benefit of some elapsed time to reflect, start to ask what it tells us about the state of health and wellbeing policy.


The big news items seem to be of two sorts.  On the one hand are things like climate change and antimicrobial resistance.  On the other there are the policy issues to do with the finance and management of health, social care and other public services, including cuts, welfare changes, changes to local government finance and debates about such things as a sugar tax.


What they have in common is a need for an evidence based, joined up, strategic approach at both national and local level.  Which seems to be missing.


Where progress is being made, it does not seem to be getting to the heart of the issue.  Devolution may do some good but is hardly a panacea.  It could take us back to the benefits of the 1980s metropolitan counties but it seems unlikely to deliver the promise of Total Place.  On the health side, the new models of care vanguards may improve things but hardly seem likely to fundamentally change the economics or effectiveness of health services.


There appear to be seismic changes to local government finance – such as ending government grant, and handing back all business rate income to localities.  However there will still be substantial central control: the 2% threshold for council tax rises before a referendum is triggered, abilities to lower but not raise business rates and some continued equalisation.  The bountiful 2% precept for social care says it all really – local government is no longer allowed to even raise its own revenue.  The problems of local government finance have been struggled with for decades, with much serious thought, but no simple solutions.  Now, it seems that a few wizard wheezes have been dreamt up for budget speech fodder, without much concern for the longer term consequences.  So we have neither a more equitable system of raising local revenue nor the ability for local councils to control their income alongside systematic equalisation to balance needs and revenue raising ability of different areas.


Changes in structure (including the widespread fear of privatisation) is only seeping, not flooding, in.  Although private provision in health is still a relatively low percentage of the whole, there is nevertheless a high proportion of new contracts going that way.  The green light for hospital chains (25/9/15) could create a number of new opportunities for the private sector.  And the softening up process continues – children’s services, it is intimated, just don’t seem to be up to the job, so if necessary, we will hand them over to independent providers.


Cuts to local government and welfare changes continue to impact on the most vulnerable and have knock on effects for health.  The flourish of meeting the Five Year Forward View demand for £8bn p.a. by 2020 soon unravels once you take into account the changed definition of ‘health’ and the immediate demands of an existing deficit and increased pension contributions.  The apparent beneficence cloaks a suffocating financial straitjacket with annual 0.9% increases exactly matching those of the last parliament but from a much more fragile base.


What there is in health, which seems to be missing from local government, is some strategic thinking.  There is a national plan, to be matched by local five year ‘Sustainability and Transformation Plans’ (22/12/15).  The worry, though, is that this doesn’t seem at all joined up with the rest of the health and wellbeing system (notwithstanding wider stakeholder involvement in the Five Year Forward View governance).  Why are local ‘system wide’ plans being mandated for health when there is an existing mechanism, the Joint Health and Wellbeing Strategies, which are designed to do exactly that but integrated across health and local government?


There needs to be a partnership, not just across the sectors, but between the national and local levels.  Many of the problems are the same across the country (obesity, diet, activity, substance abuse) with solutions such as taxation, legislation or advertising.  There is nevertheless local variation and a requirement for tailored solutions (e.g. for rural vs urban areas).


With a clear vision and concerted action, real social change would be possible.  It has been done before – from saving energy during the 1970’s three day week to wearing seat belts and smoking bans.  Now the same could be done to promote more healthy behaviour.  The Carter review only identified £5bn of the £22bn savings required for health alone.  Much of the rest must come from lifestyle changes.


It’s not easy.  But it is possible.  If there were the recognition and the willingness to take action.  And to work collectively.


A happy and healthy new year to you.


Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.