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Writer's pictureLocal Government Chronicle

Ex-health ministers call for a rethink of public health

Local government should be tasked with creating health and prosperity improvement zones to address failings in the current system, according to a cross-party commission on health and prosperity.




A three-year deep-dive into the NHS and public health has uncovered how despite efforts to improve standards in recent decades, “healthcare is currently delivering worse outcomes at higher costs” while reforms have failed because the system is “simply not organised in a way that makes change possible”.


The Institute for Public Policy Research (IPPR) commission comprised of former health ministers Lord James Bethell (Con), Mayor Andy Burnham (Lab) and Lord Ara Darzi alongside former chief medical officer Dame Sally Davies.


Their final report, published today, proposes a renewed focus on prevention through neighbourhood health centres that would provide primary care, mental health and public health.


The group advised that integrated care boards and neighbourhood structures could “revitalise the relationship with communities” and empower reform.


Their report said the government should “lean into ICSs” as the fact their formation is “done is a piece of luck for the new government” but it will “only work when the relationship between the centre and places is fixed.”


Health and prosperity improvement zones, created by local government in “places where poor health and economic outcomes cluster” could “spread the best place-level health innovations”, the report added.


It stated: “The cost of avoidable or treatable illness on prosperity is not equal. Poor health and economic outcomes cluster around much the same places – often more deindustrialised, urban, and deprived parts of the country. There, sickness locks people out of opportunity, and a lack of opportunity locks them into sickness.”


Commissioner Lord Bethell (Con) said: "For too long, the default political answer to this country's health crisis has been more of the same: more doctors, more hospitals, rinse and repeat. This commission now proves that disease and bankruptcy beckon if we unthinkingly continue with this ineffective approach.


"It's time to think differently. There is no more exciting vision for the future of Britain than in the reform agenda put forward by this report. It's time for a new health policy where we all play our part - businesses, employers, investors, individuals, communities and families alike."


Health and Prosperity Improvement Zones 

The report suggests that local government should be able to designate areas with poor health and economic outcomes as health and prosperity improvement zones (HAPI) to gain access to funding and powers to address issues.


These zones should be backed with funding from a £3bn a year pot and work with communities to co-design a 10-year plan to "deliver lasting, transformative change".


Zones could help to restore infrastructure such as libraries and leisure centres.


A “new beginning” for childhood health has been suggested with universal free school meals, restoration of Sure Start and education on wellbeing.


Dame Sally Davies, former chief medical officer for England and Wales, and a co-chair of the commission, said that “one of the most impactful choices” a government “could make is to prioritise a new beginning on childhood health”.


She said: “No one would question that education is both about a child's immediate well-being and their long-term economic prospects. The same is true for health. We simply should not tolerate a decline in our children's health any longer - it is time for bold action to ensure a healthy inheritance for future generations.”


LGA: 'Councils are central to reform' 

David Fothergill (Con), chair of the Local Government Association’s community wellbeing board, said this report “rightly highlights the need for reform in health and care” and councils are “central to achieving this vision”.


He said: “Health goes beyond health and care services, and councils play a pivotal role in tackling the broader determinants of health through their responsibilities in areas such as housing, green spaces, youth services, and local economic development.


“To effectively reduce pressure on healthcare systems, improve health outcomes, and address inequalities, it is essential to engage local government in shaping the forthcoming 10-year health plan.”


Health and Social Care Secretary Wes Streeting said he “valued engaging closely” with the commission and wants his department to focus on “economic growth because we won't build a healthy economy without a healthy society”.

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