While the Tory-led Government prioritised expensive top-down reforms to the NHS and procrastinates on meaningful reform to the funding of social care, Labour councils are pioneering new approached to their new public health responsibilities and are developing new models of social care and integration.
- Blackburn with Darwen – integrating public health
- Wigan Metropolitan Borough Council – shifting to prevention
- Coventry City Council – mainstreaming public health
- Waltham Forest London Borough Council – curbing proliferation of fast food outlets
- Lambeth London Borough Council – Street Detox Commission
- Plymouth City Council – personalising adult social care
- Manchester City Council – developing integrated healthcare delivery
- Leeds City Council – Driving up quality in independent care homes
Blackburn with Darwen Council is integrating public health throughout the council's delivery functions: health and wellbeing is one of four cross-cutting priorities for which all nine cabinet members are responsible and each directorate is responsible for five shared health and wellbeing deliverables based on the Marmot Review's life course approach. An integrated joint strategic needs assessment (JSNA) is being developed which tackles areas such as the local economy, housing, the environment and transport, and which has started to map community assets that will help develop a shared agenda for health improvement across different local actors. Blackburn with Darwen Council is working with partners to scope how the role of the CCG might become more integrated to include adult social care, public health commissioning and tackle the social determinants of health. The council is also exploring how its leisure services might be brought together with NHS prevention services into integrated wellbeing centres in which lifestyle and behaviour change professionals can support people to address problems with drugs, alcohol and obesity.
Wigan MBC is re-orientating its entire approach towards prevention by supporting frontline staff in the council and partner organisations to focus their roles towards early identification and prevention, using programmes such as ‘Making Health Everyone's Business'. This holistic approach is supported by specific targeted interventions tackling local needs, for example, the development and implementation of an integrated care pathway for managing excess weight in adults. Commissioning a range of upstream services in order to reduce reliance on expensive end stage surgery has led to recurrent cost savings of nearly £0.5 million in surgery budget and seen a decrease in prevalence of obesity in the local population.
Part of a wider transformation programme – ABC: A Bolder Coventry – the City Council included public health in a systemic review of all services. A baseline assessment of public health was carried out in 2011 and the wider determinants of health are being tackled, with acceptance of the Marmot principles, across Coventry City Council. There are designated public health posts within the planning and licensing teams. Each directorate has taken on a public health indicator – for example, children's services includes an indicator on children's health – and has to consider not just their average impact but also whether they are closing the health inequality gap. Decisions from all departments are committed to considering the public health implications. As well as this whole-council approach to public health, several specifically targeted initiatives are producing results for particular areas identified as priorities for the city. Joint working on teenage pregnancy with designated posts in the council and a joint sexual health and teenage pregnancy partnership has begun to see a decline in rates. Smoking cessation projects have included work with the council's trading standards department to take a strong role in tobacco control and regulating shisha smoking, which is leading to a reported reduction in smoking rates.
The London Borough of Waltham Forest has pioneered using planning powers to curb the spread of fast food outlets near schools, taking seriously the responsibility of tackling childhood obesity. Since the introduction of their Hot Food Take Away Planning Policy in March 2009, the overall number of outlets in the borough has dropped by 49 and hot food takeaway outlets have been restricted from opening closer than 400 meters from a school or a park. Since introducing the policy there has been a 9 per cent rise in the take-up of school meals by children in the borough.
The London Borough of Lambeth has set up a Street Detox Commission which aims maximise all powers at the council's disposal to reduce the proliferation of high street shops that sell junk food, extortionate loans, alcohol and betting, concentrations of which can expose people in poorer areas to risk and exploitation. The commission will consider the results of the council's planning and licensing reviews to find new ways to tackle the problems, review practice elsewhere and promote better alternatives on the high street such as credit unions, cooperative working, responsible retailing and greater choice.
Plymouth City Council is pioneering a personalised approach to adult social care, with a ‘customer centric' model that is used in successful retail cooperatives. People can speak to a qualified social worker when they need to, an offer of instant home care reablement is available to everyone, assessments are carried out in the home using mobile equipment and people have greater choice and control over the type of support they use, with universal information and advice available to all. The new system is achieving better outcomes for people and reducing spend on care packages because everyone has the opportunity for short term reablement and over half then require no further support. Resources are allocated fairly based on need and there is more emphasis on effective support planning. The new system has also reported very high customer satisfaction across a range of indicators and staff have reported improved job satisfaction.
Manchester City Council is working with CCGs and acute hospitals to develop a shared approach and better coordination across providers to improve the health management of people outside of hospitals. Three new integrated delivery models are being piloted in different parts of the city which will target particular ‘at-risk' patient groups, the results of which will inform data-sharing arrangements, contribute to a better evidence base of the costs and benefits of different integrated models.
Leeds City Council is seeking to actively drive up quality despite the difficult funding environment. To ensure appropriate fees are paid for places in independent sector care homes, the council set up a Board composed of councillors, officers, representatives from the care home companies and other local stakeholders, such as from the voluntary sector. The board has linked fee levels to the quality of care provided by each home, so that homes which are assessed to meet higher standards receive a higher fee level. The aim from the council's point of view was to improve the quality of care provided for older people in care homes whilst keeping fee levels affordable to the council. From the care homes' point of view, they are receiving fee levels that ensure their care homes are sustainable.