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District councils are public health’s ‘sleeping giants’ and must get bigger policy role – King’s Fund

Shutting district councils out of mainstream public health policy discourse is a mistake that urgently needs to be addressed given the role they can play in local health outcomes, the King’s Fund has found.

In a report commissioned by the District Councils’ Network (DCN) and published today (19 November), the respected health think tank argued that public health reform and localism create opportunities for district authorities to increase their contribution to health outcomes, despite central government cuts.

Their actions could also contribute major savings to the public purse – primarily, but not solely, in the NHS.

But they are not effectively integrated in local health and social care policy in higher tiers of local government, which in turn affects how they build information on the cost-effectiveness and return of their actions on public health.

The Fund argued that one of the most significant district-level contributions to public health is good-quality housing, with 40% of their stock being classed as affordable.

“Improving poor homes pays back quickly in reduced costs across the public sector. District councils have a direct role in this, and also through their enforcement powers around the condition of private rented housing.

“District councils’ efforts on housing advice and reducing homelessness are also likely to pay back in terms of finance, as well as health. On average, homeless people’s health costs are four times those of non-homeless people, costing the NHS an additional £85m annually,” report authors David Buck and Phoebe Dunn wrote.

Other distinct housing-related functions that fall within the remit of district councils can also help support prevention measures and improve social care outcomes, such as assessing individuals for Disabled Facilities Grants that fund home adaptations.

DCN chairman, Cllr Neil Clarke MBE, said: “Recent proposals for decentralisation across England and the ongoing evolution of the public sector emphasises the need for clarity and recognition of the roles districts play in ill-health prevention, and the greater understanding of the opportunities for greater collaboration and integration presented by devolution.

“This report, and the key messages and recommendations presented by the King’s Fund, provide a direction of travel for establishing districts in the mainstream of health and social care policy for the future.”

But district councils also have a role to play if they want to build on the opportunities emerging from the paradox between local government funding cuts and public policy reform.

The first of the 10 listed recommendations is to demonstrate the effectiveness of their functions and the return on investment, especially in a time where public health intervention and activity is coming under increasing scrutiny.

“Similarly, if districts are to attract funds and other forms of support from other bodies, including health and higher tiers of local government, then they need to be able to demonstrate a business case,” the report authors said.

And given the changes in the nature of funding models, districts must innovative in service design and delivery, such as through partnerships that can tackle wellbeing more effectively.

The King’s Fund also argued that district authorities must work to strengthen their enabling role in the health of their communities by promoting strong social support networks, reducing isolation, building community assets and upping volunteering.

Importantly, the think tank also urged the DCN to make sure its members are at the core of the integration and devolution agenda sweeping up the country in recent months.

Buck, co-author of the report and senior fellow of public health and inequalities at the Fund, said: “For too long, district councils have been the sleeping giants of public health.

“Maximising their role in service delivery and the wider determinants of health will be crucial for the millions of people who live in district council areas.”

(Top image c. Yui Molk, PA Images)