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Selbie: Devolution, not NHS, is where ‘most energy is’ for health creation

Devolution, combined authorities and elected mayors are where “the most energy is” and is where we should be focusing on if we want to create healthy communities, the boss of Public Health England (PHE) has argued.

Speaking exclusively to PSE ahead of his keynote speech at New NHS Alliance’s summit on health creation, Duncan Selbie, who first joined the NHS when he was 17, said the health service is not the only answer to the country’s wellbeing – and claimed local government has much to offer due to its democratic accountability and inherent ability to consult the public.

“What I’m asking for is a focus on place, and saying it’s about a place budget, not an NHS budget or a council budget or a police budget,” he continued. “It’s about a Birmingham budget or a Newcastle budget or a Suffolk budget or a Cornwall budget. So devolution, combined authorities, elected mayors – new forms of localism at scale.”

This is exactly what sustainability and transformation partnerships (STPs) are seeking to do, Selbie conceded, but they lack the democratic accountability and powers that exist in local government.

“STPs are a necessary but early step; devolution, combined authorities, elected mayors – that’s where the most energy is, and that’s where we should be focusing on.”

A key component of focusing on ‘place’ as opposed to siloed health organisations at a local level is remembering that wellbeing is not just about public health or prevention – even if these play a crucial role in keeping people healthy.

“It’s about what matters: economic growth, inclusive growth, inward investment, creating jobs that local people can get. There’s no point in creating jobs that local people can’t get if they’re trying to close the gap in the health of the people,” explained the PHE boss, who has been at the helm of the organisation since its creation in 2013.

“So it’s a very local thing. And although places like Cambridgeshire & Peterborough, North Tyneside, Greater Manchester and so on are finding their own way to achieve that, every single part of England is on this journey.

“The NHS is part of that. But it’s not the point. If we’re going to improve the health of the people, we need to improve housing, we need to improve education, we need to get more jobs. You can’t have an overreliance in the NHS.”

Of course, not every part of the country has been blessed with the powers to pool budgets, with a recent review into devolution deals even finding that no new agreements were reached between April 2016 and March last year. But Selbie doesn’t believe that should stop areas from thinking locally, and is quick to refute the claim that their hands are tied by Whitehall.

“Whitehall is not a director of what local authorities are doing and thinking in any part of the country; they’re not devolved government,” he concluded.

“But there is a deal to be had for parts of the country that are willing to rise above their own particular area, join in with others and be more in control. It’s not so much about a bigger share of the budget, but more about saying ‘we just think we can do it better.’ And I think they’re right. The whole point of devolution is about doing what matters at scale.”

Our full interview with Selbie will be available in the upcoming edition of PSE (Feb/March). To receive your free copy, subscribe here.

(Top image c. Joe Giddens/PA Images)


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