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The strength of districts

Source: PSE Aug/Sept 2018

Cllr Isobel Darby, member lead for quality of life at the District Councils’ Network (DCN) and leader of Chiltern District Council, shares some examples of district-led prevention initiatives which show the strong contribution that these collaborations can make to the health and care sector.

As the NHS reaches its 70th birthday, it’s vital that there is a renewed focus on prevention.

As the prevention authorities, district councils have a central role to play in the sustainability of health and social care services by helping people to live happier, healthier, independent lives for longer. Districts have a vital contribution to make to public health through their role as the planning and housing authorities, providing key preventative services including housing, leisure and environmental health.

There is a clear and evidence-based case for strategic health partnerships to recognise the role of these services as part of their local health care ecosystem, as well as to ensure that they are leveraged to improve public health outcomes and reduce demand for social care and acute health services.

District-led collaboration around health prevention is generating staggering returns on investment. The most recent figures show that district councils prevented or relieved more than 66,000 homelessness cases – nearly a third of England’s total – which could potentially save the NHS £85m in annual costs. Parks provide £34bn of health and wellbeing benefits, saving the NHS £111m a year through prevented GP visits. Furthermore, every £1 spent on home adaptions provides a saving of £7.50, with the same level of investment reaping more than £2 in care savings and quality of life gains to the NHS – and saving the health service £108 over 10 years in prevented falls.

Early successes

As the recent DCN Transformation in Localities Toolkit shows, districts are able to make a ‘prevention offer’ to health partners based on the importance of early intervention that takes into account wider determinants of health, such as housing and community safety; health improvement factors including smoking cessation, alcohol and substance misuse; and diet and exercise, as well as health protection issues like food safety and air quality.

Unsurprisingly, districts are creating offers to health partners containing interventions which stand to have the greatest social and financial impact, such as reducing bed-blocking in hospitals. 

For example, South Norfolk, Breckland, Broadland, North Norfolk district councils and Norwich City Council placed Home Improvement Agency officers and housing options officers at a local hospital to help speed up discharge. To date, the initiative has supported 184 patients, undertaken 290 interventions, and provided wider information and advice. The districts saved 725 bed days over 29 weeks, saved £181,250, and reduced average length of stay by 36%.

In Sevenoaks, local health priorities were to save money, cut down the number of days spent in hospital, and reduce the number of people accessing GP surgeries for non-medical reasons. Using the Better Care Fund, Sevenoaks District Council placed an adviser in GP surgeries. GPs identified their 25 ‘most persistent patients’ and in most cases, these were not the most physically ill patients, but those experiencing mental ill health, loneliness, depression and debt problems. Most of the time, they required non-medical solutions, and Sevenoaks is now involved in arranging community solutions to these problems.

Districts, through their control of housing and planning policy, can ensure that new and existing homes promote health and wellbeing. Physical and healthier lifestyles are promoted through high-quality built environments, such as green spaces, cycle paths or low density of fast-food outlets. For example, following concerns raised by local GPs and NHS Cambridgeshire on high levels of mental distress being presented in the new village of Cambourne, attributed to a lack of amenities, South Cambridgeshire District Council has introduced Health Impact Assessments. Under this policy, planning applications for major developments must submit an impact statement to show that the applicant has addressed the proposal’s effect on health.

Housing adaptations offer a crucial opportunity to improve lives, keep people well, and reduce NHS and social care pressures. Wycombe District Council’s ‘Healthy Homes on Prescription’ allows medical or social care practitioners to refer patients for simple, fast-tracked housing solutions to support independent living at home, such as a stairlift or central heating system. The scheme enables people with a long-term chronic health condition to apply for up to £5,000 without means-testing to help support their physical and mental wellbeing at home, preventing hospital admission and GP visits. It has already saved the NHS more than £53,000 and social care £133,000. 

And, by increasing the uptake of physical activity by residents, my own council in Chiltern – together with our joint working partner South Bucks District Council – estimates it is saving local healthcare services more than £65,000, and yielding a further £365,000 in wider health benefits such as quality-adjusted life years.

Whilst the priority of district councils is to serve their local communities, they are also key to ensuring the sustainability of the social care system nationally, which needs to be recognised by sustainability and transformation partnerships (STPs) and the government’s green paper. Districts can support the principles that are likely to underpin the green paper, not least through integrated care models and whole-system approaches to public health, and providing better support for families and carers by working with GPs and other partners on social prescribing to tackle loneliness. To facilitate health and social care integration, local plans by districts include implementing clusters of GP practices and co-locating services.

Districts are doing significant, effective work to lead the social care and health agenda on collaboration, but are largely absent from place-based strategic discussions around health. This must change. Our review of all 44 STPs shows that districts are named partners in only two cases. Realigning NHS-focused goals with the local focus and priorities of districts, which are on the frontline of community support, will help districts expand their vital role in public health and prevention.

Districts need to be better rewarded for their prevention focus, as highlighted in the recent District Councils APPG report. A 2% ‘prevention precept’ on council tax levied by districts – similar to the social care precept – could raise £26m a year in 2019-20 and deliver significant long-term savings many more times that amount for the NHS and social care authorities. Government should also commit to establishing a new health prevention fund which districts, alongside other councils and public bodies, can bid for to support projects that deliver preventative services and can reduce the financial burden on adult social care.

District-led collaboration initiatives are reducing demand for health and social care services. With greater recognition and further support for such cost-effective prevention work, districts can achieve even more to improve people’s lives.


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