Health and Social Care Bill – ‘a big ask’ but also a huge opportunity

Health and Social Care Bill – all 367 pages and explanatory notes as well…

There weren’t many surprises in the Bill published yesterday, but it did provide more details about, for example, the new health and wellbeing boards and about public health in the new regime and it is the start of a long parliamentary process that requires some attention from local government.

Our initial briefing, published this morning (members only), talks about risks and opportunities. We share the concerns of many others – the health reforms are radical, will take place rapidly and in a very tough financial climate. The relationships between councils and health will be under some strain; councils will have to establish new relationships with GP consortia that probably won’t be coterminous with them; and local authorities are taking on new responsibilities, when local government is facing its worst financial position in decades.

Some specific worries – the Bill is light on details of how public health and health inequality responsibilities will operate between the NHS Board, Public Health England, commissioning consortia and local authorities; the Secretary of State seems to have given himself a large number of powers to intervene in local authority public health activities; it is possible that consortia could have a duty to promote integrated working in their own right – rather than only through their role in health and wellbeing boards.

The Bill, of course, doesn’t talk money – and how much funding is transferred with the transfer of public health responsibilities, is going to be critical.

We mustn’t, however, lose sight of the very real opportunities for local government in this Bill. Whatever the details, councils will be expected to take the lead role in integrating service commissioning; there should be, despite the potential problems in working with GPs, much greater impetus for joint working, through the new, and seemingly powerful, health and wellbeing boards; and public health is coming home to local government.

The ‘big ticket’ issues will dominate the media for months to come – the impact of greater competition for example, and local authorities aren’t immune from the knock on effects of the more radical reforms in the Bill, but councils will be instrumental in making some of the key objectives happen; strengthening democratic accountability and scrutiny of local health services; greater involvement of local people and service users; and improving public health and wellbeing and reducing health inequalities. As our briefing says – ‘a big ask’ but also a huge opportunity.

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