The Health Bill and Local Government: difficult times ahead

March 8, 2012 2:59 pm

The Health and Social Care Bill is set to make fundamental changes to the NHS; changes which most within the Labour Party, do not want, and do not support. But, nestled within the Bill are a series of reforms which could have a radical and positive impact for Labour in local government. This leaves Labour authorities with difficult choices: reconciling potential tensions with the Bill at local and national levels, whilst making significant decisions about the future of health and social care in their areas.

At a local level, changes as set out in the Bill have been underway for months; Primary Care Trusts have clustered, many local authorities have adopted shadow Health and Wellbeing Boards and Clinical Commissioning Groups have established. These local level changes have been happening, irrespective of opposition, partly due to timescales, but also because at local level some of the changes set out in the Bill are welcomed by local government – on the Right and the Left. The current system across local government and health is disjointed, and could benefit from change. Labour local authorities recognise this.

Surely Labour councils are right to look at how they can strengthen their role in tackling health inequalities locally? So while this this argument is about values and is highly emotive, we shouldn’t ignore the fact that there is need for change and progress around health and social care in local government – and Labour will want to support their local authorities in making progress on this.

The most significant change proposed for local authorities is the transfer of public health and health improvement responsibilities from PCTs to local government; commissioning of public health services will transfer to local authorities. Many local authorities, including Labour authorities, have long argued that local government should have greater influence over public health. The strengthened role in ensuring greater integrated working between health and all parts of local government is also critical.

By now, most local authorities will have established ‘shadow’ Health and Wellbeing Boards – you don’t need legislation to do this. The Boards will enable local authorities to have substantial influence and responsibility over public health and joint working, and will strengthen the role of local authorities in tackling health inequalities. Because of the tight timetable around implementation of the Bill (April 2013) if local authorities are not already acting, structures would not be in place in time and would risk the National Commissioning Board taking on local commissioning – which would take powers and influence away from the local level. This hasn’t really given a choice but to press ahead with the changes now.

This all sounds positive. Labour have a growing base of power in local government, and these additional responsibilities would give councillors a stronger role and authorities real levers to make reforms locally that could positively change the lives of many. In the run up to the next general election, the Party will want to demonstrate where Labour in local government has made a real difference and local improvement in health and health inequalities. These changes could enable this.

If it is the case that the changes in the Bill for local government are positive and pressing ahead, why is there still so much opposition, even at the local level?

For all of the changes outlined above, you do not need legislation. You don’t need the Bill to promote integrated working, undertake joint commissioning (on an informal basis), or develop joint wellbeing strategies with health professionals. Without the Bill, these provisions for local government alone would be welcome. But, the problem facing Labour local government is that you can’t look at this and the new responsibilities without looking at the wider context.

The Bill will fundamentally change the NHS. Everything regarding health at the local level, including the Health and Wellbeing Boards, will be impacted upon by these changes. For local authorities, making a success of these new responsibilities around health and wellbeing will be much more difficult because of these changes to the NHS. Not least because the National Commissioning Boards will be influenced by rules on competition, which will make integration between these agendas difficult, but also because this fundamentally tests Labour founding principles around the NHS.

Laura Wilkes is a Policy Manager at Local Government Information Unit. She writes here in a personal capacity.

  • Constructive critic

    She makes a very good point a positive engagement will help local government to begin to rebuild a role in this sector which is central to the lives of many voters.

Latest

  • Comment Labour should be proud of Tony Blair’s record in Africa – and we should say so

    Labour should be proud of Tony Blair’s record in Africa – and we should say so

    This weeks attacks on Tony Blair have been the most outrageous yet. Those who disagree with Mr Blair’s decision to go to war in 2003, now use every opportunity or headline to attack his foreign affairs record and discredit his Government. But on this, they’re wrong – and we should say so. Those who have signed the petition against Blair’s acceptance of the Save the Children award simply cannot do so based on his record for international development, which the […]

    Read more →
  • Comment Will Lib Dem MPs vote for a policy that will help to close the gender pay gap?

    Will Lib Dem MPs vote for a policy that will help to close the gender pay gap?

    Today I asked Equalities Minister Jo Swinson in House of Commons whether she would vote with Labour on the 16th December on our proposal to require big companies to publish their gender pay gap. She refused to do so. Given that one of the first things the Lib Dems and Tories did after 2010 was ditch Section 78 of Labour’s Equality Act, which provided the power to require big companies to do this, this may not surprise you. But the […]

    Read more →
  • Comment East Coast – a case of too much ideology, not enough evidence from both government and unions

    East Coast – a case of too much ideology, not enough evidence from both government and unions

    So, with some surprise, the East Coast franchise has not been won by a foreign public sector operator but by a private sector operator: a Virgin/Stagecoach joint venture. Mick Cash of the RMT has called it “an act of utter betrayal”. It’s certainly true that the government wants this franchise bid done and dusted before the general election and that the Tories have an ideological commitment to private sector operation. However, that commitment is identical to the ideological dogma coming […]

    Read more →
  • News Labour will reform the water industry to help those who can’t afford to pay their bills

    Labour will reform the water industry to help those who can’t afford to pay their bills

    Today marks 25 years since the water industry was privatised. In aide of this Labour have announced that they would introduce reforms that would mean people get a better deal from water companies. These announcements will be made by Shadow Environment Secretary Maria Eagle MP at a speech in  Thurrock, Essex. Where she’ll outline that under the Coalition water bills are increasing – she’ll point out that household water bills have risen by 12.5% since 2010 – and that nothing […]

    Read more →
  • News Tory MP favourites graphic porn tweet

    Tory MP favourites graphic porn tweet

    Karl McCartney, the Tory MP for Lincoln, has left himself a little red-faced today after his Labour opponent Lucy Rigby highlighted that his recent Twitter favourites included a rather graphic pornographic photo. McCartney has now deleted all of his favourited tweets, but we still have (heavily censored) screengrab for posterity: Lincoln changed from Labour to Tory at the last election, and McCartney has a slim majority of 1,058 – it’s number 18 on Labour’s target list. A reliable bellwether, it […]

    Read more →